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TREATING CHILDREN WITH ASTHMA
Treating children with asthma has become increasingly difficult, although admittedly I do not have fond memories of measuring and adjusting theophylline levels in the 1970s and 1980s. Currently, virtually all guidelines for the treatment of children with persistent asthma mandate the use of inhaled corticosteroids (ICS). While in the past there were only a limited number of ICS, now there are many preparations available, all coming in different strengths. Masoli and colleagues from New Zealand present the results of a systematic review of the efficacy of inhaled fluticasone proprionate, suggesting a dose-response relationship that plateaus between 100 and 200 μg per day. In an accompanying perspective, George Russell comments on two critical aspects of asthma management—adherence and titration to the lowest effective dose of ICS. Many questions remain. For example, at what dose of ICS should leukotriene receptor antagonists or long acting β2 agonists be added to “spare” the steroid dose? How do we manage children …
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