In spite of the progress of scientific knowledge,
asthma remains an intractable disease.
The target of the therapeutic strategy
is therefore the greatest possible improvement
of the patient’s quality of life.
Inhaled glucocorticoids (IGCS) are at present
the best therapeutic tool in chronic
asthma. They have a strong local activity
with minimal systemic effects. Atopic patients
with persistent airflow obstruction
should receive IGCS irrespective of age.
IGCS should be used as first therapeutic
step to reduce bronchial hyperreactivity
while other drugs such as sodium cromoglycate
should be used only to maintain clinical
remission. The choice of the best device
to administer IGCS (inhaler, spray, turbohaler,
nebulizer) depends on the age
and the needs of the child. The daily dose
should not exceed 10-15 mg (beclometasone
equivalent) and, as a rule, the minimum
effective dose should be used. A single cumulative
dose at 5 p.m. is as effective as
two or three divided doses. Side effects are
negligible when these indications are followed.
At present, there is not clear evidence
for IGCS in the treatment of acute asthma