Japan Today Japanese pediatric guidelines for the treatment and management of bronchial asthma 2008 Naomi Kondo, 1,5 Toshiyuki Nishimuta, 2,5 Sankei Nishima, 3,5 Akihiro Morikawa, 4,5 Yukoh Aihara, 5 Toru Akasaka, 5 Akira Akasawa, 5 Yuichi Adachi, 5 Hirokazu Arakawa, 5 Takao Ikarashi, 5 Toshiichi Ikebe, 5 Toshishige Inoue, 5 Tsutomu Iwata, 5 Atsuo Urisu, 5 Motohiro Ebisawa, 5 Yukihiro Ohya, 5 Kenji Okada, 5 Hiroshi Odajima, 5 Toshio Katsunuma, 5 Makoto Kameda, 5 Kazuyuki Kurihara, 5 Yoichi Kohno, 5 Tatsuo Sakamoto, 5 Naoki Shimojo, 5 Yutaka Suehiro, 5 Kenichi Tokuyama, 5 Mitsuhiko Nambu, 5 Yuhei Hamasaki, 5 Takao Fujisawa, 5 Takehiko Matsui, 5 Tomoyo Matsubara, 5 Mitsufumi Mayumi, 5 Tokuko Mukoyama, 5 Hiroyuki Mochizuki, 5 Koichi Yamaguchi 5 and Shigemi Yoshihara 5 1 Department of Pediatrics, Graduate School of Medicine, Gifu University, 5 Japanese Society of Pediatric Allergy and Clinical Immunology, Gifu, 2 National Hospital Organization, Shimoshizu National Hospital, Chiba, 3 Department of Pediatrics, National Fukuoka Hospital, Fukuoka and 4 Department of Pediatrics and Developmental Medicine, Gunma University, Graduate School of Medicine, Gunma, Japan Abstract The fourth version of the Japanese Pediatric Guidelines for the Treatment and Management of Bronchial Asthma 2008 (JPGL 2008) was published by the Japanese Society of Pediatric Allergy and Clinical Immunology in December 2008. In JPGL 2008, the recommendations were revised on the basis of the JPGL 2005. The JPGL 2008 is different to the Global Initiative for Asthma guideline in that it contains the following items: a classification system of asthma severity; recommendations for long-term management organized by age; a special mention of infantile asthma; and an emphasis on prevention and early intervention. Here we show a summary of the JPGL 2008 revising our previous report concerning JPGL 2005. Key words acute attacks, childhood asthma, prevention, guideline, long-term management. After the publication of the first version of the Japanese Pediatric Guidelines for the Treatment and Management of Bronchial Asthma (JPGL) in 2000, the pediatric asthma mortality rate decreased in Japan. However, the methodology of asthma treat- ment has evolved over the years, and the JPGL were revised in 2002, 2005, and 2008 1,2 by the Japanese Society of Pediatric Allergy and Clinical Immunology (JSPACI). In the JPGL 2008, we revised our recommendations on the basis of the JPGL 2005. The JPGL 2008 is different to the Global Initiative for Asthma (GINA) guideline 2006 3 in that it contains the following items: a classification system of asthma severity; recommendations for long-term management organized by age; a special mention of infantile asthma; and an emphasis on prevention and early intervention. 1 Here we show a summary of the JPGL 2008 revising our previous report concerning JPGL 2005. 4 Definition, pathophysiology, diagnosis, and classification of childhood asthma In previous years, asthma was defined as a respiratory disease involving a chronic airway inflammation, airway remodeling, and recurrent symptoms of airway narrowing, including episodes of dyspnea, wheezing, and coughing. Patients commonly show bronchial hyperresponsiveness associated with chronic allergic inflammation of the airway, mainly due to environmental allergens. 4,5 Similarly to adult asthma, childhood asthma is also consid- ered to be a chronic inflammatory airway disease. However, there are some differences between children and adults in the mecha- nism of an asthma attack, and the pathophysiology of asthma attacks in children is not fully understood. An assessment of the severity of a patient’s asthma attacks is essential in developing a plan for the adequate treatment and management of the disease. Childhood asthma attacks are clas- sified into four stages of severity: mild attacks, moderate attacks, severe attacks, and acute respiratory failure. The criteria for each of these stages are shown in Table 1. With regard to the percentage of peak expiratory flow (PEF), GINA guidelines and other guidelines established in Japan have adopted PEF measured after b2-agonist inhalation, as a reference point. This PEF reflects airflow limitation and reversibility, and is useful for evaluating the severity of attacks. 6 In the JPGL 2008, similarly to JPGL 2005, it is recommended that PEF should be measured both before and after b2-agonist inhalation. Regarding the severity of asthma, the classification system outlined by the JSPACI has been used for a long time and it includes mild asthma, moderate asthma, and severe asthma. Correspondence: Naomi Kondo, md phd, Department of Pediatrics, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan. Email: nkondo@gifu-u.ac.jp Received 5 November 2009; accepted 19 November 2009. Pediatrics International (2010) 52, 319–326 doi: 10.1111/j.1442-200X.2009.03010.x © 2010 Japan Pediatric Society