Challenges to treatment goals and outcomes in pediatric asthma

To achieve long-term control in pediatric asthma, it is essential to establish treatment goals acceptable to both the patient and care giver and to choose appropriate outcome measures that will show the benefits of the treatment. Differences between the perceptions of patients and care givers of what constitutes a desirable treatment goal, and poor perception of asthma control by both patient and physician, hinder optimal treatment of asthma. The use of objective outcome measures in pediatric asthma generally can provide a good evaluation of asthma severity as well as a basis for setting treatment goals that are acceptable to patients and care givers alike. Objective measurements that assess airway inflammation, which is the fundamental pathophysiology in asthma and the underlying mechanism for chronic airway remodeling, may be the most useful means for gauging pediatric asthma control and evaluating response to treatment. Techniques such as exhaled nitric oxide analysis, bronchoalveolar lavage, and sputum analysis, although used primarily in research, have successfully identified the level of airway inflammation in children. Furthermore, the association of meaningful outcome measures with education about the long-term effects of uncontrolled asthma and the need for anti-inflammatory treatment should help in developing treatment goals and strategies that will be acceptable to both patient and care giver.