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Asthma is the most common chronic disease of South African children, affecting 10-20% of the population. Correct treatment of chronic asthma with regular antiinflammatory controller therapy prevents symptoms, asthma exacerbations, hospitalisation and mortality. Modern treatment of asthma focuses on an assessment of asthma control in order to enable the child to lead a normal life by: • Growing and developing normally • Attending school regularly • Sleeping well at night • Participating in sport and activities • Staying out of hospital. With good controller treatment, less acute attacks of severe asthma will take place. However, to ensure fewer hospitalisations and less mortality, optimal treatment of acute attacks by families and health care professionals is critical.

Wheezing in young children is problematic for most practitioners. Difficulties arise in both the diagnosis and management of this clinical phenotype. Not all preschool children who wheeze have asthma. Therefore, we suggest that the “Ten Commandments” of managing preschool wheezing include thinking that in very young infants (< 1 year) wheezing is likely to be viral in origin; realising that allergy testing is mandatory to diagnose the cause of early wheezing; taking a history of asthma and allergy in family members; noting that chronic coughing is a pointer to asthma; using the term “asthma” if thatis the diagnosis; ensuring that the environmental avoidance of triggers is addressed; using a short course of montelukast for virus-induced wheezing episodes; avoiding steroids to treat virus-induced wheezing; treating associated nasal symptoms; and making sure that the follow-up of children addresses the issue of stopping therapy if it is not working.

Asthma is the most common chronic disease of South African children, affecting 10-20% of the population. It is sometimes difficult to diagnose. Where uncertainty exists, it may be more beneficial to treat the child as asthmatic, and then wean him or her off the medication later once it is under control, than neglect to administer the correct therapy to a true asthmatic. The treatment of asthma is often problematic, not because of lack of access to appropriate medication, but because of the central role played by additional factors, such as patient adherence and administration of medication technique. It is always necessary to treat the child as an individual, but some measures apply in all cases. It is important to allay anxiety about the diagnosis. This is best done by carefully explaining the nature and causes of asthma, what to do if an attack occurs, why medicines are prescribed, and how they are given. Patients must be able to understand the difference between controller and reliever therapy. The importance of regularly using controller medication needs to be emphasised. Time spent on the initial explanation and educating the parents and the child is always well rewarded by the response to treatment. Regular follow-up of these children, preferably by the same doctor, is very important.

Childhood asthma is characterised by episodes of wheezing and coughing, particularly at night. The cough is typically non-productive of sputum and is irritating and persistent. It is most troublesome in the early hours of the morning, especially between 1-2 am. Chronic cough may be a presenting symptom in young children. Wheezing, chest tightness, and shortness of breath become more obvious in children older than three years. Acute exacerbations of asthma are frequently associated with viral upper respiratory tract infections, but may also be triggered by exercise, particularly in cold and dry weather, laughter, crying, and exposure to allergens and irritants such as petrol or paint fumes. There may be a seasonal variation in symptoms, and it is common to find a diurnal variation with waking in the early hours of the morning, and increased symptoms on getting out of bed.