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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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