INTRODUCTION
Asthma is the most common chronic childhood disease in nearly all industrialized countries.
Nevertheless, there are few national and international guidelines that focus exclusively on pediatric asthma.
The information available on specific aspects of pediatric asthma, in particular in children under 5 years of age, is limited and does not include the opinion and contributions of the pediatric allergy and respiratory community.
In contrast to adults, the evidence base for pharmacotherapy and randomized controlled trials in children less than 5 years of age is very sparse. The most accessible source of information for treatment of pediatric asthma - with recommendations of the available literature - is lacking the evidence based on expert opinion.
In view of the limited data from randomized controlled trials in children and the difficulties in applying systematic review criteria to diagnosis, prognosis and non pharmacological management, the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology nominated expert teams to find a consensus to serve as pediatric expertise guidelines for clinical practice of childhood asthma. This consensus report is a part of the PRACTALL initiative, which is endorsed by both academies and was published at (Allergy Journal. 2008; 63:5-34).
What is PRACTALL?
“PRACTicing ALLergology program on childhood asthma”
The PRACTALL Pediatric Asthma Group consists of approximately 40 international experts in pediatric allergy and asthma. The paper includes the natural history & patho-physiology of childhood asthma phenotypes and recommendations for diagnosis, management, and monitoring. The major breakthrough of PRACTALL is that it simplifies all the existing asthma management guidelines for children. This is a short navigation through Practall consensus report for Pediatric Asthma.
First: Thinking "Phenotype"
What is a phenotype?
A phenotype is defined at (Oxford English Dictionary, 2005) as: "A type of organism distinguishable from others by observable features." i.e. it is a cluster of different characteristics that defines a subgroup within a disease, and is apparent at the time of consultation.
In asthma, age and triggers can be used to define different phenotypes of disease. These phenotypes are likely to be useful because they recognize the heterogeneity of childhood asthma. They do not represent separate diseases, but are part of the asthma syndrome. Guidelines that recognize different phenotypes should provide better direction for prognosis and therapeutic strategies.
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