Chronic Asthma
Paediatrics - Chronic Asthma
Asthma is recurrent reversible lower airways obstruction (air trapping) in any age child. You thus have to demonstrate a bronchodilator response. Perform and record the results of a bronchodilator response test. It is less common in younger children but can be diagnosed in infants less than 1 year of age.
History is vital
- night cough
- exercise cough
- atopy/eczema/known triggers
- family history/cigarette exposure
- recurrent LRTI or wheezing
Classify Asthma according to severity:
Infrequent asthma: less than one acute exacerbation in 4–6 months
Persistent asthma: mild, moderate or severe
Classification of asthma severity presenting for the first time on no treatment | |||
| Criteria | Mild | Moderate | Severe |
| Day Time Symptoms | 2-4/week | >4/week | continuous |
| Night Time Symptoms | 2-4/month | >4/month | frequent |
| Prior Admission To Hospital For Asthma | none | one previous admission | > one previous admission or admission to ICU |
| PERF | >80 | 60-80 | <60 |
Management
- Diagnoses correctly (note differentials of wheezy child)
- Identify allergens and reduce exposure
- Avoid other known triggers
- Education on every visit. Give asthma diary.
- Spacer and mask technique and medicine review on every visit (ask moms to bring medicines, pumps and spacer with mask)
- Uses PEFR for evaluation and review of children above 5 years old
First assess of severity and initiate therapy (see table above)
- Intermittent asthma
- Short acting B2 agonist (Salbutamol: Ventolin/Asthavent) 1-2 puffs (100-200mcg) PRN only
- Mild persistent asthma
- Add budesonide (Budeflam) 100mcg bd
- Moderate persistent asthma
- Add budesonide (Budeflam) 200-400mcg bd
- Severe persistent asthma
- Budesonide 400mcgbd.
- Add long acting B2 agonist (Salmeterol: Serevent) 1 puff (25mcg) bd
- Refer for additional treatment to allergy clinic
Adjust above therapy based on level of control (All children should be controlled)
Levels of asthma control | |||
| Characteristics | Controlled (all of the following) | Partly controlled (any measures present in any week) | Uncontrolled (≥3 features in any week) |
| Daytime symptoms: wheezing, cough, difficulty breathing | < 2/week | > 2/week | > 2/week |
| Limitation of activities | None | Any | Any |
| Nocturnal symptoms | None | Any | Any |
| Need for reliever | < 2/week | > 2/week | > 2/week |
| PERF | Normal | <80% | <80% |
For complete management protocols see Guideline For The Management Of Chronic Asthma In Children (Published in SAMJ Dec 2009). Copy in protocol file in doctor’s office or on paarlpaeds website.