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Pediatric Asthma ICON & future of asthma
guidelines
Dr. Nikos Papadopoulos
Head, Allergy Dpt, 2nd Pediatric Clinic, University of Athens
Asthma is a dynamic disease presenting
with different faces in the growing child:
infants, toddlers, school-age children and
adolescents, all have their particularities
in how asthma affects them. There is also
variability in the triggers that make the
disease exacerbate: in children common
cold infections are the most usual trigger,
while pollen and other allergens become
more frequent with increasing age. Other
differences are related with the tools avai-
lable for diagnosis, which are much less in
younger children than in older children or
adults. Finally, children do not respond to
medication in the same away adults do.Ta-
king into account that much less research
has been performed in children, makes
pediatric asthma management rather cha-
llenging
Identifying the best practice, based on
the available evidence, but also on the
knowledge and experience of experts is
very important for primary care physicians
and pediatricians, who rely on such infor-
mation, as they have to deal with asthma
every day. A straightforward, easy to un-
derstand and implement guideline is a
constant requirement. On the other hand,
there have been several extensive docu-
ments on the topic, so we needed to agree
which are the common practices and if
there are differences, what is their reason.
All these have been achieved through the
ICON Pediatric Asthma
ICON is a collaboration between the Euro-
pean Academy of Allergy and Clinical Im-
munology (EAACI), the American Academy
of Allergy Asthma and Immunology (AAA-
AI), the World Allergy Organisation (WAO)
and the American College of Allergy Asth-
ma and Immunology (ACAAI).
ICON has identified many common recom-
mendations in all the different guidelines
around the globe: asthma should be consi-
dered as a chronic disease of inflammation
and therefore its treatment should be long-
term. The goal of treatment is keeping pa-
tients under control, ie with no or minimal
symptoms, good lung function and good
quality of life and protect them from dan-
gerous exacerbations.This can be achieved
with a comprehensive approach, including
identification and avoidance of triggers,
education, drug treatment, in some cases
allergy treatment and always close moni-
toring.
If doctors provide easy to understand and
correct advice and patients follow these
closely, asthma symptoms are much less
or disappear and the quality of life of the
patients and their families increases a lot.
Understanding of the disease and develo-
ping a healthy life-style further contributes
to this.
Several crucial points have been pointed
out by ICON, which have to be included in
order to improve future pediatric asthma
guidelines. New information on pathophy-
siology and diagnosis should increase our
understanding. In particular, understan-
ding the differences between asthma phe-
notypes and producing phenotype-specific
guidelines is an important necessity. Fur-
thermore, all guidelines should be adapted
to local needs: ICON may serve as a star-
ting template for the development of such
documents
