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State of the art review
Improving the global diagnosis and management of asthma in children
  1. Warren Lenney1,2,3,
  2. Andrew Bush4,5,6,
  3. Dominic A Fitzgerald7,8,
  4. Monica Fletcher3,9,
  5. Anders Ostrem10,
  6. Soren Pedersen11,
  7. Stanley J Szefler12,13,
  8. Heather J Zar14,15
  9. on behalf of the GSK Paediatric Project Advisory Board and Committee
    1. 1 Department of Child Health, Keele University, Stoke-on-Trent, UK
    2. 2 Department of Child Health, Royal Stoke University Hospital (RSUH), Stoke-on-Trent, UK
    3. 3 Global Respiratory Franchise, GlaxoSmithKline, Brentford, London, UK
    4. 4 Paediatrics, Imperial College London, London, UK
    5. 5 Paediatrics, National Heart and Lung Institute, London, UK
    6. 6 Paediatrics, Royal Brompton & Harefield NHS Foundation Trust, London, UK
    7. 7 Sydney Medical School, Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
    8. 8 Department of Respiratory Medicine, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
    9. 9 Asthma UK Centre for Applied Research (AUKCAR), University of Edinburgh, Edinburgh, UK
    10. 10 Gransdalen Legesenter, Oslo, Norway
    11. 11 Pediatric Research Unit, Kolding Hospital, University of Southern Denmark, Kolding, Denmark
    12. 12 Pediatric Asthma Research Program, Section of Pediatric Pulmonary Medicine, Breathing Institute, Children’s Hospital Colorado, Aurora, Colorado, USA
    13. 13 Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
    14. 14 Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
    15. 15 MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
    1. Correspondence to Professor Warren Lenney, GlaxoSmithKline, 980 Great West Road, London TW8 9GS, UK; w.lenney46{at}hotmail.co.uk

    Abstract

    Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of asthma diagnosis and management globally still needs substantial improvement. From infancy to the teenage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. Guidelines are increasingly evidence based, but their impact on improving outcomes has been negligible in many parts of the world, often due to lack of implementation. New thinking is needed to enable substantial improvements in outcomes. The disease varies globally and plans will need to differ for individual countries or places where region-specific barriers prevent optimal care. A wide selection of educational activities is needed, including community-targeted initiatives, to engage with families. The Paediatric Asthma Project Plan has been initiated to strengthen diagnosis and management of asthma. This encompasses a vision for the next 10–15 years, building on the knowledge and experience from previous educational projects. It will take into account the educational needs of patients, carers and healthcare professionals as well as the accessibility and affordability of medication, particularly in low and middle-income countries where the prevalence of asthma is rising more rapidly. This overview presents a first step for those involved in the diagnosis and management of childhood asthma to strengthen care for children globally.

    • asthma
    • asthma epidemiology
    • asthma guidelines
    • paediatric asthma

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

    https://doi.org/10.1136/thoraxjnl-2018-211626

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      Footnotes

      • Contributors Drafting/revising: all authors. Final approval or publication: all authors. Agreement to be accountable for all aspects (accuracy/integrity): all authors.

      • Funding This study was funded by GlaxoSmithKline.

      • Competing interests WL is a GlaxoSmithKline (GSK) employee and GSK shareholder. AB has nothing to disclose. DAF has consulted for GSK and Merck, Sharp & Dohme. MF is a GSK employee and GSK shareholder. AO has consulted for GSK and Boehringer Ingelheim. SP reports personal fees from AstraZeneca, personal fees from Chiesi and personal fees from ALK, outside the submitted work. SJS has consulted for Aerocrine, AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, GSK, Genentech, Merck, Novartis, Roche and Teva and has received research support from the National Institutes of Health, the National Heart, Lung and Blood Institute, the National Institute for Allergy and Infectious Diseases, the National Institute of Environmental and Health Sciences, the Environmental Protection Agency, the Colorado Cancer, Cardiovascular and Pulmonary Disease Program and GSK. HJZ reports grants from Allergy Society of South Africa, grants from South Africa Medical Research Council and other from GSK, outside the submitted work.

      • Patient consent Not required.

      • Provenance and peer review Not commissioned; externally peer reviewed.