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Understanding and Managing Childhood Asthma: A Comprehensive Guide

Asthma prevalence in the UK is particularly high among children, with a significant rise in cases over the past four decades. Early symptoms typically present before age 5, and those with severe asthma during childhood may continue to experience severe symptoms in adulthood. Common symptoms include wheezing, coughing, and chest tightness. Accurate diagnosis and management are crucial, encompassing inhaled corticosteroids as the main treatment, lifestyle changes, and patient education for self-management, aiming to minimize acute exacerbations and enhance quality of life.

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Understanding and Managing Childhood Asthma: A Comprehensive Guide

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  1. Asthma in Children Dr Rashmi Gaekwad ST3 7/11/12

  2. Background • UK- highest prevalance rate for Asthma • 1:13-adults, 1:8 children • Numbers increased in last 4 decades • Majority develop symptoms before 5 y • Children with more severe asthma during school years-severe asthmatics in adult life

  3. High probability of asthma • Wheeze, cough, chest tightness, difficulty in breathing-frequent and recurrent, worse at night/exercise. • History of Atopic disorder-eczema, allergic rhinits • F/H of atopic disorder • Wheeze on auscultation • h/o improvement in symptoms/Lung function in response to adequate therapy • Diagnosis of Asthma

  4. Lower probability of Asthma • Only colds • Isolated cough • Normal chest exam-symptomatic • Normal PF/ Spirometry-symptomatic • No response to trial of asthma therapy • Diagnosis other than Asthma • Detailed Investigation/Specialist Referral

  5. Non-pharmacological Rx • Primary- BF, Avoidance of Tobacco smoke, weight reduction-obese • Secondary- exposure to allergen (carpets/pillow), furry pets, Parents to stop smoking, Buteyko Breathing Technique

  6. Acute Asthma • Acute Severe • SpO2<92%, PEF-33-50% • Too breathless to talk or feed • Pulse >125(>5y) or >140 (2-5) • Respiration >30 (>5) or >40 (2-5)

  7. Life threatening • SpO2 <92% PEF <33-50% • Hypotension • Silent chest • Exhaustion • Confusion • Cyanosis • Poor respiratory effort

  8. Criteria for admission • Beta-2 Agonist- 2 puffs every 2 min-10 puffs- not improved-transfer with nebs/O2 • Severe and life threatening-transfer to hospital

  9. Goals-therapy • No day time symptoms • Reduce no of acute exacerbation • No night time awakening-due to asthma • No need for rescue medication • No limitations on physical activity • Normal lung function FEV1>80% • Reduce Absences from school

  10. Long term mgmt • Inhaled Corticosteroids-best option-monotherapy. • Leukotriene Receptor Antagonist-alternative • Long acting Beta2 Agonist –not for maintenance monotherapy

  11. Mgmt • Prednisolone -20mg(2-5),30-40mg (>5)-3days(weaningif >14days) • Beta-2 Agonist+Ipratropium • Aminophylline-HDU/PICU

  12. Under 2 years • Assessment of acute asthma difficult. • Intermittent wheezing- viral infection • Response to asthma medication- inconsistent • DD-aspiration pneumonia, brochiolitis, tracheomalacia, CF, congenital anomalies • Prematurity and LBW-risk factor for recurrent wheezing

  13. Drug Delivery devices • Pressurised MDI+spacer+mask-3yrs • pMDI+spacer-3-5yrs • Dry powder inhalers->5yrs • Breath actuated inhalers- older children

  14. Primary care • Reviewed by Nurse or Doctor • Incorporate a written action plan • Maintain a Register • Patient education-self –mgmt shown to improve health outcomes.

  15. Bottom line • Childhood Asthma –clinical diagnosis, >6y objective measures- confirm • Inhaled steroids-controller • A/E-good discharge plan-reduce admission • Good self mgmt plan-reliever, controller, acute

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