1. GINA Guidelines : particularités pédiatriques Dr G de Bilderling Pneumologie pédiatrique CHR Namur

2. Prevalence increasing in many countries, especially in children Prevalence increasing in many countries, especially in children Factors that Exacerbate Asthma : Factors that Exacerbate Asthma : Viral infections +++ Viral infections +++ Asthma Diagnosis Asthma Diagnosis Spirometry > 6y Spirometry > 6y Measurements of allergic status Measurements of allergic status

3. Asthmatic phenotypes MartinezJ Allergy Clin Immunol 2003;111:661 -75 Pronostic 1

4. Modified Asthma Predictive Index < 3 years and recurrent wheezing episodes 2 criteria : allergic rhinitis Wheezing episodes not associated with URTI Eosinophilia 75% of these children will have active asthma 1 criteria : Parental asthma Atopic dermatitis or and Castro-Rodriguez AJRCCM 2000;162: 1403-1406 Pronostic 7 Aeroallergern sensitization

6. SUMMARY OF STEPWISE MANAGEMENT IN CHILDREN LESS THAN 5 YEARS British guidelines on the management of asthma. Thorax 2003, 58

7. Estimate Comparative Daily Dosages for Inhaled Glucocorticosteroids by Age Drug Low Daily Dose (  g) Medium Daily Dose (  g) High Daily Dose (  g) > 5 y Age 5 y Age 5 y Age < 5 y Drug Low Daily Dose (  g) Medium Daily Dose (  g) High Daily Dose (  g) > 5 y Age 5 y Age 5 y Age < 5 yBeclomethasone 200-500 100-200 >500-1000 >200-400 >500-1000 >200-400 >1000 >400 >1000 >400Budesonide 200-600 100-200 600-1000 >200-400 600-1000 >200-400 >1000 >400 Budesonide-Neb Inhalation Suspension 250-500 250-500 >500-1000 >500-1000 >1000 >1000 Ciclesonide 80 – 160 80-160 80 – 160 80-160 >160-320 >160-320 >160-320 >160-320 >320-1280 >320 Flunisolide 500-1000 500-750 >1000-2000 >750-1250 >2000 >1250 >2000 >1250 Fluticasone 100-250 100-200 >250-500 >200-500 >250-500 >200-500 >500 >500 >500 >500 Mometasone furoate 200-400 100-200 > 400-800 >200-400 > 400-800 >200-400 >800-1200 >400 Triamcinolone acetonide 400-1000 400-800 >1000-2000 >800-1200 >2000 >1200

8. Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom Todd GRG, Acerini CL, Ross-Russel R, Zahra S, Warber JT, McCance D. Arch Dis Child 2002; 87: 457-461. ChildrenAdults Males/females (n)17/113/2 Males/females (n)17/113/2 Mean age (yrs) :6.4 (3.3-10)41 (18-80) Mean age (yrs) :6.4 (3.3-10)41 (18-80) Presentation (n) : Presentation (n) : Acute hypoglycaemia231 Acute hypoglycaemia231 Decreased consiousness/coma130 Decreased consiousness/coma130 Coma and convulsions101 Coma and convulsions101 ( Death: pneumococcal septicaemia)1 pneumococcal septicaemia)1 Insidious54 Insidious54 Duration of ICS R/ (yrs)1.7 (n = 22)3.3 (n = 4) Duration of ICS R/ (yrs)1.7 (n = 22)3.3 (n = 4) Mean dose of FP 9801380 in µg/day (range)(500-2000)(1000-2000 Mean dose of FP 9801380 in µg/day (range)(500-2000)(1000-2000

9. Age-related devices AgeFirst choiceSecond choise 0-2MDI+spacer, facemask Nebulisations 3-6MDI+spacerNebulisations 6-12 (SABA)MDI+spacer, Breath actuated, DPI - 6-12 (chronic) MDI+spacerDPI 12+ (SABA)Breath actuated, DPI - 12+ (chronic) MDI+spacerDPI, breath actuated ExacerbationMDI+spacerNebulisations

10. Aérosols doseurs : UTILISATION INCORRECTE Deux asthmatiques sur trois utilisent mal les aérosols* 1 - secouer préalablement avant l’usage 2 - débuter l ’inspiration avant d’activer l’inhalateur 3 - inhaler doucement et profondément 4 - activer l’inhalateur en une seule fois 5 - retenir sa respiration 5 sec ou + après inhalation technique optimale 72 64 58 62 78 68 67 82 60 55 22 20 fréquence d’usage correct des inhalateurs (%) adultes enfants * résultats d’une enquête INSERM sur 768 patients adultes et enfants

11. Young children are more difficult to diagnose. Young children are more difficult to diagnose. Treatment (inhalation device) must be adapted to age. Treatment (inhalation device) must be adapted to age. Partnership is even more important in this age-group. Partnership is even more important in this age-group. Young children are more difficult to diagnose. Young children are more difficult to diagnose. Treatment (inhalation device) must be adapted to age. Treatment (inhalation device) must be adapted to age. Partnership is even more important in this age-group. Partnership is even more important in this age-group. Asthma Management and Prevention Program: Summary