1. Acute and chronic management of childhood asthma
Dr S Wa Somwe
Adapted from GINA and BTS guidelines

2. Primary therapies for exacerbations:
Asthma Management and Prevention Program Component 4: Manage Asthma Exacerbations
Primary therapies for exacerbations:
Repetitive administration of rapid-acting inhaled β2-agonist
Early introduction of systemic glucocorticosteroids
Oxygen supplementation
Closely monitor response to treatment with serial
measures of lung function

3. Reliever Medications Rapid-acting inhaled β2-agonists
Component 4: Asthma Management and Prevention Program
Reliever Medications
Rapid-acting inhaled β2-agonists
Systemic glucocorticosteroids
Anticholinergics
Theophylline
Short-acting oral β2-agonists

4. Controller Medications
Component 4: Asthma Management and Prevention Program
Controller Medications
Inhaled glucocorticosteroids
Leukotriene modifiers
Long-acting inhaled β2-agonists
Systemic glucocorticosteroids
Theophylline
Cromones
Long-acting oral β2-agonists
Anti-IgE

5. Children Less than 5 yrs 5

6. Children Less than 5 yrs 6

7. Children Less than 5 yrs 7

8. Children Less than 5 yrs 8

9. Children Less than 5 yrs 9

10. Children age 5-12 yrs 10

11. Children age 5-12 yrs 11

12. Children age 5-12 yrs 12

13. Children age 5-12 yrs 13

14. Children age 5-12 yrs 14

15. Children age 5-12 yrs 15

16. Asthma in Apollo private Hospital
Trained specialist doctors
investigations to exclude/ confirm other conditions
PFT to assess severity and reversibility
90% patients treated with inhaled corticosteroids
prompt access to Emergency services and ICCU
Personal presentation, Raj Singh, Syria May 2003

17. Levels of Asthma Control
Characteristic
Controlled
Partly controlled (Any present in any week)
Uncontrolled
Daytime symptoms
None (2 or less / week)
More than twice / week
3 or more features of partly controlled asthma present in any week
Limitations of activities
None
Any
Nocturnal symptoms / awakening
Need for rescue / “reliever” treatment
More than twice / week
Lung function (PEF or FEV1)
Normal
< 80% predicted or personal best (if known) on any day
Exacerbation
One or more / year in any week

18. 1 2 3 4 5 LEVEL OF CONTROL TREATMENT OF ACTION TREATMENT STEPS REDUCE
controlled
partly controlled
uncontrolled
exacerbation
LEVEL OF CONTROL
maintain and find lowest controlling step
consider stepping up to gain control
step up until controlled
treat as exacerbation
TREATMENT OF ACTION
INCREASE
TREATMENT STEPS
REDUCE
INCREASE
STEP 1 2 3 4 5

20. Without actions asthma drugs are available only for rich patients
and for animals in rich countries!
New Zealand.
Sunday Star. Times
January 4,2004
Photo : Kevin Stent

21. “Those who care for the patients can be taught to manage cases well with what is available.”
E Parry
The Tropical Health & Education Trust
London
Thorax1997;52:589