TABLE IV.

Key points and recommendations for pediatric populations

Recommended definition: An exacerbation is a worsening of asthma requiring the use of systemic corticosteroids (or, for patients on a stable maintenance dose, an increase in the use of systemic corticosteroids) to prevent a serious outcome. This definition is the same for pediatric (aged 0–4 and 5–11 years) as for adult and adolescent populations. Although the use of SABA is a more commonly employed criterion or factor for defining “exacerbation” in children, the threshold criterion for distinguishing between loss of control and an asthma exacerbation has not been defined. Therefore, this criterion could not be included as a core outcome. Asthma exacerbations in children aged 0–4 years are particularly difficult to identify for several reasons. Foremost is the consideration that the differentiation between changes in daily symptoms and a potential cluster of symptoms sufficient to be termed an exacerbation is based on the caregiver’s perception of symptoms and not the child’s perception. The threshold for symptom identification and initiation of therapy depends on the education level and personality of the caregiver. Currently, biomarkers are not useful in defining “exacerbation.” However, for older children (aged 5–11 years), biomarkers may be useful in better understanding the biology and mechanisms of exacerbation and in identifying the population at risk for exacerbation. Many physiological measures (ie, FEV1) and biomarker techniques (FeNO, induced sputum, and exhaled breath condensate) are age dependent and difficult to use reliably in young children.

FeNO, fractional exhaled nitric oxide; FEV₁, forced expiratory volume in 1 second; SABA, short-acting β-agonist.