ABSTRACT
Twenty years ago, the majority of children with asthma received only
intermittent anti-asthma treatment in association with exacerbations of the disease. Evolution of treatment since then has included the use of con-
tinuous treatment with theophylline, b2-agonists or sodium cromoglycate for children with moderate or severe, persistent asthma. During the 1990s,
nedocromil sodium was introduced as an alternative to these drugs and
the use of inhaled corticosteroids increased markedly. Initially inhaled cor-
ticosteroids were reserved for patients with severe and moderate persistent
asthma, who were not controlled on other drugs, but later they became first
choice of treatment in these disease severities. Over the last 10 years several studies have reported an often unexpectedly high morbidity and impairment
also in patients with mild persistent asthma (1-4). This morbidity has been
shown to be markedly reduced by continuous treatment with inhaled corti-
costeroids (1-3). Therefore, most international guidelines now recommend
inhaled corticosteroids as the preferred first-line treatment for patients with
mild, moderate, and severe persistent asthma rather than reserving this
therapy for the more severe cases. This change in practice is often referred to as early intervention with inhaled corticosteroids. However, in the present paper the term early intervention will be used in its original meaning, which
is initiation of a treatment early in the course of the disease. In contrast, a child who has had symptoms compatible with asthma for years before
he/she is diagnosed or given treatment with inhaled corticosteroids as
the first choice will be defined as receiving inhaled corticosteroids as
first-line treatment.
