A new BC Guideline developed by Child Health BC in collaboration with the Guidelines and Protocols Advisory Committee provides recommendations for diagnosis and management of asthma in patients aged 1 to 18 years presenting in a primary care setting. The guideline is available to physicians across British Columbia at www.BCGuidelines.ca [10] and includes new action plans and flow sheets.

Key recommendations

• Send children aged 6 years and older for spirometry when they are symptomatic to improve accuracy.
• Send patients for spirometry regularly as part of the assessment of asthma control.
• Prescribe controller medication daily and not intermittently.
• Controller medication does not need to be increased with an acute loss of asthma control in children.
• At each visit, assess for proper use of asthma medication devices and medication compliance as these are common reasons for poor asthma control.
• Prescribe an age-appropriate spacer device for patients using metred dose inhalers (MDI).
• Send all patients and families to an asthma education centre to learn self-management (where available).
• Given that many children less than 6 years of age outgrow their asthma symptoms, reassess the persistence of symptoms every 6 months in this age group.
• There is insufficient evidence to recommend one inhaled corticosteroids molecule over another with respect to efficacy or safety.
• Ensure children have normal activity levels and do not limit physical activity to control asthma symptoms.
• Complete a written asthma action plan with each patient and reassess this plan with the patient on a regular basis.