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Recent Discoveries in Preventing and Controlling Childhood Asthma
another study in 280 children with asthma between five and 12 years barriers and motivational and confrontational interviewing. A ‘new’
of age, double-blind treatment with beclomethasone extra-fine target for prevention of asthma is overweight/obesity. Trials assessing
200 micrograms daily or CFC fluticasone proprionate 200 micrograms the effectiveness of weight reduction and exercise programmes for
daily for up to 18 weeks resulted in equal effectiveness.
77
Both the primary or secondary prevention of asthma in children are
drugs were well tolerated. The new inhaled corticosteroid ciclesonide necessary. Immunotherapy may prevent asthma in at least some
has extra-fine particles and its active metabolite desisobutyryl– children, but new blinded, placebo-controlled studies are needed.
ciclesonide is produced in the airways by esterases, which may lower There are problems with an early asthma diagnosis in children. In the
the systemic availability. Whether this results in fewer systemic side future, it is likely that an early diagnosis will be possible by means of
effects is yet to be evaluated.
21
non-invasive measurements of inflammatory markers in exhaled
breath (condensate) or airway resistance. By means of an early
Summary asthma diagnosis, it is expected that overtreatment of children with
Asthma in children is a complex disease with various phenotypes. It is ‘transient or viral wheeze’ and undertreatment of true asthmatics can
difficult to prevent the development of the illness. There is evidence be prevented. The hypothesis that the control of childhood asthma
that multifaceted interventions directed towards allergen reduction, can be improved by adding measurements of inflammatory markers
breastfeeding in the first year of life and exposure to passive smoking is logical but still has to be proved. New techniques include
are effective for the primary prevention of asthma, whereas mono- inflammatory markers in EBC and VOCs in exhaled breath. Inhaled
interventions are not. The compliance of families towards measures corticosteroids with extrafine particle size are particularly of interest
reducing exposure to passive smoking is low. New interventions in children with asthma. So far, studies have demonstrated similar
directed against passive smoking exposure in children should be efficacy of beclomethasone extra-fine and fluticasone at equal doses,
developed and tested. Such interventions should include an but no extra effect of beclomethason extra-fine on peripheral airway
individual, family-tailored approach with education, assessment of inflammation was found. ■
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