Treatment of asthma: From the child to the...
2
USE Y·DO OTCGn INTRODUCTION Treatment of asthma: From the child to the adult 4A A sth ma is One Of themOSt COllll11011 respiratory ai[me nlS in in dus tri a li zed COU ntries and_ Still res ults in . unacceptable morh1d1ty and mortality rates. O ur und ersta ndrng of the 111ccha111s ms of- devclo pmc111 ol asthma has increased si g nificantly in the past few years and. as a result. it s management has chan ge d progress ive ly. Many conse nsus statements providin g treat ment guid elines have bee n pub li s hed for both adult and child hoo d asthma. Usua lly. the ped iat ric and ad ult aspects of asth ma m an a geme nt have bee n considered separat e ly. I-lowewr . we now realize that the physi opallwlogy of asth ma is quite ~imilar in ch ildren and adults an d that thL' approach to tre atment should be base d on simi lar g rounds. w ith an e mphas is on e nvironm en tal control and early trea tment of airway infla mmati o n. At a symposium in Mo ntreal, Quebec on Dece mbe r 4, l 993. represen tat ives of the ped iatric and adult mi lieux gathered under the auspices of the Que bec T horacic Soc iety, the Quebec As thma Edu catio n Net work and the Univers ity of Mon treal C ontinuin g Me dical Ed ucation Bu rea u to discuss a longitudinal ap proach to asthma treatme nt in adults and children. Reporting from this last symposium and taking into account rec en tl y published studi es , the contributors tn this sup plemen t revi w man y cr iti ca l issues in asthma trea tme nt an d try to ans wer su ch ques tions as: Do asthmatic child ren become asth ma ti c adu lts and, if so. can we prevent this? Is the sugges ted role of inhaled corticosteroids as first-line drugs in asth m::i ju st ifi e d? Can cortico steroids lead to as thma r em i ssio n in children or adults'? Is th ere still a pl ace fo r nonste roidal bronchial anti -i nflammat or y agents or theo phylline? Is reg ular use of beta2-agonists really detr imen tal'! How sh ould we use long-a ctin g beta2-agonists' 1 S hould we pro vide asthma educa tion and act i on plans to all asthm atic pat ient and. if so , how and whe n? Should pati ents m easure their peak expi ratory flow rates reg ularly'! Wh at will be t he main de ve lo pme nts in as thm a treatmen t over the next few years? Is it possible to see any c ure coming for asth ma? Wha t is the ·Que bec Asth ma Ed uc at ion Ne twork '? The co ntributors to this suppll'mcnt do not wan t to du plicat established asth ma treatm L·nt g ui de lines. but wish to provide further disc ussion arou nd the c on trovers i es in curren t asthma trea tmen t. We hope that it wil l prove useful to t hose who hav e to make da y-to-day th erapeut ic dec isions in ch ildren or adults pres en ting with a thrna, and be a sourcl' of stimulation to t hose searchi ng for new approac hes and trea tme nts aimed at red ucing the s ti ll exc essive morbidity associ ated with this disease . We wish to thank those pharmaceuti cal c ompan ies wlm gene rously sup ported the symposi um. and Astr a and G la xo for the sponso rship nf this proc eedings. Louis-Philippe Boulet MO Centre de Pneumologie de l'H6pital Laval Sainte-Foy, Quebec Robert Thivierge MD H6pital Sainte-Justine Montreal. Quebec Can Respir J Vol 2 Suppl A March 1995
Transcript of Treatment of asthma: From the child to the...
USE Y·DO OTCGn INTRODUCTION
Treatment of asthma: From the child to the adult
4A
Asthma is One Of themOSt COllll11011 respirat o ry ai[menlS in indus tri a li zed COU ntries and_ Still results in . unacceptable morh1d1ty and mortality rates. O ur understandrng of the 111ccha111sms of- devcl opmc111 ol
asthma has increased significantly in the pas t few years and. as a result. its management has changed progressive ly. Many consensus statements providing trea tment guide lines have been publi shed for bot h adult and chi ldhood asthma. Usua lly. the ped iatric and adult aspects o f as thma management have been considered separate ly. I-lowewr. we now reali ze that the physiopallwlogy of as thma is quite ~imilar in ch ildren and adults
and that thL' approach to treatment should be based on simi lar g rounds. w ith an emphas is on environmenta l control and early treatment of airway in flammation.
At a symposium in Montreal , Q uebec on December 4, l 993. representat ives of the ped iatric and adult mi lieux gat he red under the auspices of the Quebec T horacic Soc iety, the Quebec Asthma Education Ne twork and the Univers ity of Montreal Continuing Medical Education Bureau to disc uss a longitudinal approach to asthma treatment in adults and children. Reporti ng from this last symposi um and taking into account recen tl y publi shed studies , the contributors tn this supplement revi w many critical iss ues in asthma treatment and try to answer
such questions as: Do asthmatic children become asthmati c adu lts and, if so. can we prevent this? Is the suggested role of inhaled corticoste roids as firs t-line drugs in asthm::i just ified? Can cort icoste roids lead to asthma rem ission in children or adults'? Is there st ill a place fo r nonste roidal bronchial anti -i nflammatory agents or
theophylline? Is regula r use of beta2-agoni sts really detr imental'! How should we use long-acting beta2-agonists'1
Should we provide asthma education and act ion plans to all asthmatic patient and. if so, how and when? Should patients measure their peak expi ratory flow rates regularly'! What will be the main de ve lopments in asthma treatment over the next few years? Is it poss ible to see any cure coming for asthma? What is the ·Quebec Asthma Educat ion Network '?
The contributors to this suppll'mcnt do not wan t to du pl icat est abli shed asthma treatmL·nt guidelines. but wish to provide further disc uss ion around the controvers ies in current asthma treatmen t. We hope that it wil l prove
use ful to those who have to make day- to-day therapeut ic dec is ions in ch ildren or adul ts presenting with a thrna, and be a sourcl' of stimulation to those searching for new approaches and treatme nts aimed at red ucing the sti ll excessive morbidity associ ated w ith this disease.
We wish to than k those pharmaceutica l compan ies wlm generously supported the symposi um. and Astra and
G laxo for the sponsorship nf this proceed ings .
Louis-Philippe Boulet MO Centre de Pneumologie de l'H6pital Laval Sainte-Foy, Quebec
Robert Thivierge MD H6pital Sainte-Justine Montreal. Quebec
Can Respir J Vol 2 Suppl A March 1995
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