Childhood Asthma Part Two: Management Update
Part one of this two-part practice guideline reviewed the initial assessment, diagnosis, evaluation, and education of children with asthma (part 1 appeared in the January/February 2007 issue of Journal of Pediatric Health Care). Part two will focus on the management of children with acute and chronic asthma.

After a comprehensive history, physical examination, laboratory studies, and exclusion of other diagnoses, the diagnosis of asthma is made. Asthma therapy is tailored to the four classifications of asthma severity based on the patient's symptoms at the time of diagnosis as described previously and repeated in Table 1 . The goals of asthma therapy include maintaining normal activity, prevention of asthma symptoms, prevention of asthma exacerbations, maintaining normal pulmonary function testing, minimizing adverse effects of the medications, and promotion of healthy living with patient and family satisfaction (National Asthma Education and Prevention Program [NAEPP], 1997).

There are two approaches to gain control of asthma. The first approach starts medications at the asthma severity step appropriate at the time of diagnosis. The second approach begins medications at a higher level to achieve control rapidly. The expert panel recommends this latter approach to decrease airway inflammation. Medications are then increased or decreased over time depending on asthma severity and control (NAEPP, 1997).