Improving the monitoring and treatment of childhood astma

This thesis initiates practical alternative and innovative methods to improve the monitoring (part A) and treatment (part B) of childhood asthma, empowering pediatricians to make more substantiated clinical decisions for asthmatic children and to optimise the basics of asthma care.

PART A
Exercise-induced bronchoconstriction (EIB) is a specific morbidity of childhood asthma and a sign of insufficient disease control. In daily practice, EIB is often evaluated with self-reported respiratory symptoms and spirometry. In chapter 2 we analyse the capacity of pediatricians to predict EIB based on information routinely available during an outpatient clinic visit.
In chapter 3, we study the ability of pediatricians to assess EIB from post-exercise videos and evaluate the predictive value of different physical symptoms for EIB. In chapter 4, we evaluate the Visual Analog Scale (VAS) for dyspnea as a novel tool to detect EIB in asthmatic children. We also assess the value of combining the VAS with C-ACT and ACT scores for prediction of EIB.

PART B
Inhaled corticosteroids (ICS) form the cornerstone of asthma controller therapy. However, not all asthmatic children and adolescents respond equally to ICS. In chapter 5 we evaluate whether the response to a single dose of ICS (beclomethasone dipropionate, Qvar) can function as a predictor for individual long-term ICS efficacy. A correct inhalation technique and sufficient therapy adherence are vital for the effectiveness of asthma therapy.
In chapter 6, we compare daily inhalation technique at home with two frequently used inhalers in the treatment of childhood asthma: the Diskus® and Autohaler®. In chapter 7, we present a protocol to study the protective effect of azelastine/fluticasone proprionate (Dymista) on EIB in children. Results may help improve asthma control and quality of life in children with both asthma and allergic rhinitis.