Global strategy for the diagnosis and management of asthma in children 5 years and younger.

Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease as measured by school absences, emergency department visits, and hospitalisation. During the past two decades, many scientific advances have improved our understanding of asthma and our ability to manage and control it effectively. However, in children 5 years and younger, the clinical symptoms of asthma are variable and non-specific. Furthermore, neither airflow limitation nor airway inflammation, the main pathologic hallmarks of the condition, can be assessed routinely in this age group. For this reason, to aid in the diagnosis of asthma in young children, a symptoms-only descriptive approach that includes the definition of various wheezing phenotypes has been recommended. In 1993, the Global Initiative for Asthma (GINA) was implemented to develop a network of individuals, organizations, and public health officials to disseminate information about the care of patients with asthma while at the same time assuring a mechanism to incorporate the results of scientific investigations into asthma care. Since then, GINA has developed and regularly revised a Global Strategy for Asthma Management and Prevention. Publications based on the Global Strategy for Asthma Management and Prevention have been translated into many different languages to promote international collaboration and dissemination of information. In this report, Global Strategy for Asthma Management and Prevention in Children 5 Years and Younger, an effort has been made to present the special challenges that must be taken into account in managing asthma in children during the first 5 years of life, including difficulties with diagnosis, the efficacy and safety of drugs and drug delivery systems, and the lack of data on new therapies. Approaches to these issues will vary among populations in the world based on socioeconomic conditions, genetic diversity, cultural beliefs, and differences in healthcare access and delivery. Patients in this age group are often managed by pediatricians and general practitioners routinely faced with a wide variety of issues related to childhood diseases.

[Is guideline-defined asthma control achievable?--secondary publication. The Gaining Optimal Asthma ControL (GOAL) Study]. / Er guideline-defineret astmakontrol opnåelig?--sekundaerpublikation. The Gaining Optimal Asthma Control (COAL) Study.

In this study, the percentage of patients with uncontrolled asthma who can achieve guideline-defined asthma control was assessed in 3,421 patients. Significantly more patients (71%) treated with salmeterol-fluticasone achieved asthma control than did patients receiving fluticasone alone (59%). The patients treated with salmeterol-fluticasone achieved asthma control more rapidly and at a lower dose of inhaled corticosteroid than did patients treated with fluticasone alone. Achievement of asthma control was associated with marked improvements in exacerbation rates and quality of life. Thus guideline-defined asthma control can be achieved in the majority of patients and should be the goal of asthma treatment.