Table 5.
Indications for initial low-dose ICS controller therapy in children aged 5 years and below
| Indication to start low-dose ICS: Symptom pattern consistent with asthma (Box 1) and asthma symptoms not well-controlled (Box 2), or at least 3 exacerbations per year OR Symptom pattern not consistent with asthma, but wheezing episodes occur frequently (e.g. every 6–8 weekly) | |||
|---|---|---|---|
| BOX 1: Features suggesting a diagnosis of asthma in children 5 years and younger | |||
| Feature | Characteristics suggesting asthma | ||
| Cough | Recurrent or persistent non-productive cough that may be worse at night or accompanied by some wheezing and breathing difficulties Cough occurring with exercise, laughing, crying or exposure to tobacco smoke in the absence of an apparent respiratory infection |
||
| Wheezing | Recurrent wheezing, including sleep or with triggers such as activity, laughing, crying or exposure to tobacco smoke or air pollution | ||
| Difficult or heavy breathing or shortness of breath | Occurring with exercise, laughing or crying | ||
| Reduced activity | Not running, playing or laughing at the same intensity as other children; tires earlier during walks (wants to be carried) | ||
| Past or family history | Other allergic disease (atopic dermatitis or allergic rhinitis) Asthma in first-degree relatives |
||
| Therapeutic trial with low dose ICS and as-needed SABA | Clinical improvement during 2–3 months of controller treatment and worsening when treatment is stopped | ||
| BOX 2: GINA assessment of asthma control in children 5 years and younger | |||
| Symptoms in the last 4 weeks | Level of control | ||
| Well controlled | Partly controlled | Uncontrolled | |
| Daytime asthma symptoms for more than a few minutes, more than once a week | None | 1–2 of these | 3–4 of these |
| Any activity limitation due to asthma (Runs/plays less than other children, tires easily when walking/playing) | |||
| Reliever medication (excludes reliever taken before exercise) needed more than once a week | |||
| Any night waking or night coughing due to asthma | |||
Legend:
SABA short acting beta2-agonist
Evidence A – data from randomized controlled trials and meta-analyses, rich body of data
Evidence B – data from randomized controlled trials and meta-analyses, limited data
Evidence C – data from nonrandomized trials/observational studies
Evidence D – panel consensus judgment
modified from GINA 2015 [3]