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Thus determining the presence or absence of bronchial hyper-responsiveness to a trigger at a
certain concentration is not necessarily diagnostic of asthma. The direct challenges lack
specificity, while the indirect challenges lack sensitivity. Both challenge types are required to
be done in the laboratory and while they are achievable with children, there is both a safety
component and a significant time commitment to be considered. As repeated measures to
monitor response to treatment or progression of asthma, they are less than satisfactory for
these reasons.
In summary while the diagnosis of asthma may seem straightforward in some who fit the
'classical' asthma profile, there are many difficulties to be faced when testing for asthma. In
addition, the investigations are more suited for asthma determination in adults than in
children. A diagnosis of asthma in children remains difficult, when in this group getting the
correct diagnosis is important if the usual asthma treatment is to be recommended.
1.5
Treatment and concerns
1.5.1 Possible adverse fficts of asthmatreatment in children
Much is known about the underlying pathology of asthma, and this will be discussed in depth
in the next section of this chapter. This has resulted in all the guidelines (GINA 2005;
Paediatric Society of New Zealand. 20O5; SIGN 2005) recommending anti-inflammatory
treatment; with IHCS at step two as the first preventer and the introduction of oral
corticosteroids at steps four or five with unresponsive and difficult asthma, and for acute
treatment. The balance is between the correct diagnosis, appropriate management and to
prevent irreversible airway thickening on the one hand, against the development of side
effects with treatment on the other.
The adverse effects as listed in the guidelines for IHCS include; adrenal cortical insufficiency,
growth failure, dysphonia and oral candidiasis. The adverse effects listed for oral
corticosteroids is somewhat lengthier; adrenal insufficiency which may cause devastating
hypoglycaemia, adrenal suppression, growth failure, hypertension, diabetes mellitus,
reduction in bone mineral density, skin atrophy, straie, poor healing, immunosuppression and
cataracts. Doses of IHCS of greater than 400p gtday of beclomethasone dipropionate or
equivalent in children have been associated with side effects (Calpin, Macarthur et al. 1997:
Sharek and Bergman 2000). There have been reports of IHCS affecting short term growth
(Agertoft and Pedersen 1997), intermediate term growth over months to a year (Tinkelman,
Reed et al. 1993; Doull, Freezer et al. 1995; Simons 1997; Verbeme, Frost et al. 1997;Allen,
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