The Thoracic Society of Australia and New Zealand
Recommendations from The Thoracic Society of Australia and New Zealand. The Thoracic Society of Australia and New Zealand (TSANZ) is the only health peak body representing a range of professions (medical specialists, scientists, researchers, academics, nurses, physiotherapists, students and others) across various disciplines within the respiratory/sleep medicine field in Australia and New Zealand.
Do not prescribe combination therapy (inhaled corticosteroids with long-acting beta2 agonist) as initial therapy in mild to moderate asthma before a trial of inhaled corticosteroids alone.
Even for children with persistent asthma, the most recent evidence suggests that adding long-acting beta2 agonists (LABA) to inhaled corticosteroids (ICS) does not result in a statistically significant reduction in exacerbations. However, there is some evidence that LABA/ICS combination therapy increases the risk of hospital admissions and severe asthma-associated adverse events, particularly among asthmatic children aged 4 to 11 years old. Due to the limited paediatric evidence on the safety and efficacy of long-acting beta2 agonists, the use of ICS alone is therefore recommended for the initial preventative therapy and the only therapy for children with mild to moderate asthma.
- Canadian Agency for Drugs and Technologies in Health (CADTH). Long-Acting Beta2-Agonist and Inhaled Corticosteroid Combination Therapy for Adult Persistent Asthma: Systematic Review of Clinical Outcomes and Economic Evaluation. CADTH Technology Overviews. 2010;1(3):e0120.
- Chauhan BF, Chartrand C, Ni Chroinin M, et al. Addition of long-acting beta2-agonists to inhaled corticosteroids for chronic asthma in children. Cochrane Database Syst Rev. 2015 24;(11):CD007949.
- McMahon AW, Levenson MS, McEvoy BW, et al. Age and Risks of FDA-Approved Long-Acting 2-Adrenergic Receptor Agonists. Pediatrics. 2011;128(5):e1147-54.
- van Asperen PP, Mellis CM, Sly PD, Robertson C. The role of corticosteroids in the management of childhood asthma. The Thoracic Society of Australia and New Zealand, 2010.
The Royal Australasian College of Physicians worked with a Lead Fellow nominated by TSANZ to review evidence for 12 paediatric thoracic recommendations on low-value care in paediatric thoracic medicine. These recommendations were the subject of email discussions and deliberation by members of the Paediatric Special Interest Group (SIG) of the TSANZ. They were further discussed at a workshop held at a meeting of the Asia Pacific Society of Respirology in 2017, which included TSANZ members. Based on the feedback provided at this workshop and through email discussions with members of the SIG, four were removed and two of the original 12 were considered for inclusion in the final recommendations with overwhelming support. Members of the Paediatric SIG were then invited to choose three out of the remaining six through an email based poll. This served as the basis for final recommendations, which were further refined and developed through successive drafts based on the input of the Lead Fellow, the results of consultation with other specialty groups and the views of the TSANZ Board.
- 1 Do not prescribe combination therapy (inhaled corticosteroids with long-acting beta2 agonist) as initial therapy in mild to moderate asthma before a trial of inhaled corticosteroids alone.
- 2 Do not prescribe antibiotics for exacerbation of asthma.
- 3 Do not use oral beta2 agonists as bronchodilators in asthma, wheeze or bronchiolitis.
- 4 For children with bronchiolitis without other co-morbidities, do not delay discharge from an inpatient admission based on oxygen saturations alone if saturations are ≥90%.
- 5 Do not delay immunisation/s based on presence of mild respiratory symptoms in the absence of fever.