Current aspects of the therapy of bronchial asthma in childhood

The management goals common to all age groups are to reduce symptoms, to permit a normal physically active lifestyle, and to prevent irreversible airway obstruction. Main measures are environmental manipulation (avoidance of allergen contact, cigarette smoke and pets; psychotherapeutic management), assessment of severity, training for self management, hyposensitization (pollen, HDM, insect venoms) and pharmacotherapy. Medication should be adapted to age and severity of the disease, and the different drugs should be used stepwise. The first step includes the application of bronchodilators in which beta-2-stimulants are to be preferred. If we use spacers or jet nebulizers infants can also be treated successfully. The value of xanthines is discussed controversially. The next steps tend to reduce the inflammatory reaction. In this direction sodium cromoglycate and ketotifen are useful especially in childhood, and inhaled steroids have increasing importance. The use of oral corticosteroids should be the last step.