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Inhalation December 2018 31 quency of exacerbations, response to previous therapies and pheno- type heterogeneity. Depending on age group, step-up strategies in- clude increasing doses of inhaled corticosteroid and adding leuko- triene receptor antagonist, tiotro- pium and/or biologics. Age-related differences in asthma treatment "Differences in diagnosis and man- agement of asthma in children re- flect differences in development of their respiratory systems, particu- larly for younger children," said Leonard Bacharier, MD, coauthor of the pediatric yardstick. An MD Magazine article about the pediat- ric yardstick noted that "the age- related physiological changes con- sidered in the guidelines for their impact on evaluating and treating asthma include bronchial hyper- responsiveness, which decreases during school age but is more se- vere with asthma. Other described changes include lung compliance decreasing with age, with commen- surate increase in elastic recoil pres- sure; and chest wall compliance, which also decreases with age and is associated with rib cage distortion and unstable functional residual ca- pacity in preschool children." Chipps and colleagues also stud- ied differences in socio-behavioral factors among children. "Other factors include challenges related to daily activities and emotional and social concerns, particular for adolescents," explained Bachari- er. "Comorbid conditions and non-adherence with treatment, for example, due to the stigma of having a chronic condition and taking medicine, can affect out- comes for older children." Sources for development of the yardstick In developing the pediatric yard- stick, the authors reviewed current data on dosing and combined treatments, and age-related adverse Figure 2 effect profiles. According to MD Magazine, they also considered the United States Food and Drug Ad- ministration's review of four large clinical safety trials with combina- tions of inhaled corticosteroids and long acting beta-adrenergic bronchodilators and their resulting removal of a boxed warning. References Content for this article was based on and excerpted from: • Chipps, et al. e pediatric asthma yardstick: Practical rec- ommendations for a sustained step-up in asthma therapy for children with inadequately controlled asthma. Ann Allergy Asthma Immunol (2018) 120: 559–579. • New pediatric asthma yardstick has treatment guidance for children of every age. American College of Allergy, Asthma & Immunology. July 19, 2018. • ACAAI provides "yardstick" for controlling asthma in children. MD Magazine. July 20, 2018. • Pediatric Asthma Yardstick aids physicians in stepping up treat- ment. Healio. July 13, 2018. Back Page continued from page 32