Therapeutic Approach to Childhood Asthma

Astma u djece heterogena je bolest upale dišnih putova, različitih fenotipova i endotipova, kao i različitih kliničkih manifestacija, koja ovisi o dobi, spolu, genetskoj podlozi te okolišnom utjecaju. Astma u djece obično je povezana s alergijskom senzibilizacijom. Liječenje i kontroliranje astme ponajprije je usmjereno prema nastojanju da se suzbije alergijska upala upotrebom protuupalnih lijekova (inhalacijski kortikosteroidi, antagonisti leukotrijenskih receptora i dr.) te olakšavanjem bronhokonstrikcije bronhodilatatorima. Terapija se uglavnom određuje na temelju procjene stupnja težine bolesti te procjene stupnja kontrole bolesti, zbog čega obje kategorije mogu u bilo kojem trenutku varirati. Nažalost, unatoč dostupnosti učinkovitih terapijskih mogućnosti, nedostatna kontrola astme prisutna je kod mnogih pacijenata diljem svijeta. Postoji hitna potreba za identifikacijom same podloge nastanka astme kako bi se shvatili kompleksni genski i okolišni utjecaji, te kako bi se razvila primjerena terapijska strategija.Asthma in childhood is an infl ammation of airways, i.e. a heterogeneous disease with diff erent phenotypes and endotypes and variable clinical manifestations which depend on age, gender, genetic background and environmental infl uences. In children asthma is usually associated with allergic sensitization. Asthma treatment and management is primarily directed towards suppressing airway infl ammation with anti-inflammatory drugs (inhaled corticosteroids, leukotriene receptor antagonists etc.) and relieving bronchoconstriction with bronchodilators. Therapy is determined to a large extent following an initial assessment of severity and subsequent establishment of control, both of which can be variable over time. Unfortunately, despite the availability of effective therapies, asthma control is suboptimal in many patients worldwide. There is an urgent need to identify the underlying basis of asthma, understand the complex genetic and environmental influences, and develop an appropriate treatment strategy