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Colom et al.20O4; Guilbert, Morgan et aL.2006). Side effects noted were growth velocity
(Guilbert, Morgan et al. 2006), adrenal suppression, increased cough and hoarseness, and
cataract formation (Bisgaard, Allen et al. 2004). An earlier Cochrane review in 2000 had
suggested that episodic high dose IHCS was partially effective. However, they concluded that
"there is no current evidence to favour maintenance low dose IHCS in the prevention and
management of episodic mild viral wheeze of childhood" (McKean and Ducharme). In
addition, more recent Cochrane reviews do not support the use of IHCS in acute bronchiolitis
or used to prevent wheezing post acute illness in 2006 (Blom, Ermers et al.) or the use of oral
steroids for bronchiolitis in 2004 (Patel, Platt et al.). So while at the current time steroids are
not recommended in this age group, the increased use exposes many more children to
corticosteroid therapy, often before a definitive diagnosis of classic asthma is able to be made
(de Blic and Scheinmann 2000).
In fact it is interesting to note within the guidelines, the significant difference in the level of
evidence available for the different age groups. For example in the pharmacological
management chapter of the SIGN guidelines (SIGN 2005), the graded evidence for the
recommendations is presented in age brackets (>12 years and adults, 5-12 years and < 5
years). Across these age groups the evidence frequently drops from '1++' (strong evidence
with high quality meta-analyses and systematic reviews of randomised controlled trials) down
to '4' (expert opinion) in the youngest age group.
1.5.2 A marker for inflammation would be usefuI
There is a need to minimize side effects, while preventing morbidity (and mortality). This is
important for better individual health, and is also important financially - reducing work and
school days lost. Other financial burdens can be experienced by a family with a child with
uncontrolled asthma as revealed in this quote taken from the 'Trying to Catch Our Breath,
monograph (Anonymous 2006) :
"I visited a family who had almost no furniture in the house. They had taken their child
to the doctor one evening in the previous week for an asthma attack. They spent $80 for
the visit and the medications. This was their entire food budget for the following week.
They were eating white bread and butter." (Claire Richards, Asthma Nurse Educator,
Porirua Asthma Service, New Zealand)
In 2005, the GINA guideline (GINA 2005) suggested to "titrate the dose of inhaled
corticosteroid to the lowest dose at which effective control of asthma is maintained". The
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