Adjusting Controller Medications in Children: Evidence for Step Up and Down Choices after EPR-3

Evidence regarding long-acting beta-agonist safety and specific step up and step down recommendations in children that have been published since the National Asthma Education Prevention Program Guidelines for the Diagnosis and Management Expert Panel Report 3 are reviewed. Despite several systematic reviews involving many thousands of patients, the safety of long-acting beta-agonists in children remains under debate. Although the role of inhaled corticosteroids has been well established in children, whether the ideal add on therapy should be a long-acting betaagonist or a leukotriene receptor antagonist, balancing efficacy with safety information, remains controversial. The ideal step down regimen to be used after asthma control has been achieved is similarly not well established. Additional research in children is needed to answer these questions, particularly in the youngest age groups.