Optimizing inhalation therapy in childhood asthma

Childhood asthma is a common chronic disease, featured by inflammation of the airways and episodic bronchoconstriction. Exercise is an important trigger for bronchoconstriction in asthmatic children. They experience this symptom, limiting participation in play and sports, as the most bothersome aspect of their asthma. Symptoms of exercise induced bronchoconstriction (EIB) can be subtle and stay unrecognized by caregivers and parents, compromising social and motor development. Asthmatic children may adapt to their exercise limitations and avoid symptoms. An exercise challenge test (ECT), especially in cold dry air, can objectify asthmatic symptoms and can be used for diagnosing and monitoring asthma. A cornerstone in asthma treatment is inhalation medication. In this thesis we investigated various aspects of inhalation therapy in childhood asthma with the aim of optimizing this therapy. This thesis investigated factors contributing to maintenance medication adherence, the influence of the body posture during medication inhalation and the optimalization of inhalation technique. Also we analyzed the protective effect of a single regular dose of inhalation corticosteroid against exercise induced bronchoconstriction, the protective effect of salbutamol against exercise induced inspiratory flow limitation and the correlation between the difference in mannitol responsiveness between baseline and after a single dose of inhalation corticosteroid and the difference in mannitol responsiveness between baseline and after four weeks of inhalation corticosteroid treatment which turned out to be highly correlated. This means change in mannitol responsiveness after a single dose of inhalation corticosteroid could provide objective information predicting the effectiveness of long term regular treatment.