2024-03-26 16:23:14
In preschool children, it is essentially based on the frequency of interictal symptoms and the assessment of risk factors for exacerbation (at least one severe crisis in the previous year, environmental smoking, pollution, allergen exposure, poor compliance) .
The decision-making algorithm (fig. 2) distinguishes 4 levels:
- level 1: infrequent virus-induced wheezing AND few interictal symptoms: no background treatment ;
- level 2: insufficiently controlled signs or more than one exacerbation in the year requiring corticosteroids: CI at low daily dose for at least 3 months;
- level 3: situation out of control despite low-dose ICs: doubling of the dosage (up to the average dose) or addition of montelukast;
- level 4: specialist opinion.
The response to treatment should be regularly assessed: every 3 to 6 months.
After stabilization, we try to reduce the corticosteroid dosage gradually until the minimum effective threshold. For most young children, it is possible to interrupt it during the summer period.
The management of exacerbations must be anticipated, with a written action plan explained to parents: it encourages them to call the doctor (or the healthcare system) in the absence of response to a beta 2 -mimetic after 1 hour or when the seizure is unusual.
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