child hood asthma

1. Childhood Asthma
Dr.Rajesh.K

2. • Definition:
• a chronic inflammatory disorder of the
airways resulting in recurrent episodes of
wheezing,breathlessness,chest tightness and
cough,particularly at night and in the early
morning and may relieved by a
bronchodilator.

3. •The inflamation also causes increased airway
hyperreactivity to a variety of stimuli like viral
infections,cold air,exercise,emotions,allergens
pollutants .
•conditions such as aspiration, GERD, airway
anomaly, foreign body, cystic fibrosis, vocal cord
dysfunction, etc have been ruled out

4. Clinical manifestations
• cough,increased work of
breathing{tachypnea,retractions or accessory
muscle use},wheezing,hypoxia
andhypoventilation
• No audible wheezing may indicate very poor
air movement and severe broncho spasm
• Chest X-ray shows peribrochial
thickening,hyperinflation,and patchy
atelectasis.

5. •Consider diagnosis of persistent asthma if…
•recurrent episodes cough with or without wheeze
•Cough that is associated with exercise/play
•symptoms greater than 2 days per week.
•night awakenings greater than 2 times per month
secondary to asthma
•patients require more than 2 steroid bursts per year
•FEV1 <80%
•FEV1/FVC <80% (>5 years old) and <85%(8-19 years old)

6. • >12% increase in FEV1 post-bronchodilator on
spirometry.
• Assessment:
• assess RR,HR,work of breathing,02 saturation,
peak expiratory flow,alertness,color.

7. Childhood wheezing
• 2 phenotypes of child hood wheezing
• Episodic viral wheezer: some episodes of
wheezingcough with attacks of cold and fever.
• Multitrigger wheezer: repeated episodes of
cough and wheezing.worsening of symptoms
when exposed to smoke,laughs,weeps.
• Both entities can occur in all age groups.

8. Pulmonary score index
score Respiratory rate
<6yrs >6yrs
wheezing Accessory muscles
involvement(sternocliedoma
stoidmuscle etc)
0 <30 <20 no none
1 31-45 21-35 Terminal
expiration
Questionable ,increase
2 46-60 36-50 Thoughout
expiration
Increase apparently
3 >60 >50 Inspiration
expiration
All muscles involved
0-3-mild
4-6 –moderate
>6 (6-9)--severe

9. Intial management
• Give o2 to keep saturation>95%
• Administer inhaled B-agonists:nebulized
albuterol,0.05 to 0.15mg/kg/dose as often
needed.
• Ipratropiumbromide,0.25 to 0.5mg,nebulized
with albuterol acts to decrease airway secretions.
• Benefit has been demonstrated only for
moderate to severe exacerbations and its effect is
not titrable(give early but no benefit has been
shown from repeated doses)

10. • Steroids:methylprednisolone,2mg/kg IV/IM
bolus,then 2mg/kg/day divide every 6hr or
prednisone 2mg/kg PO every 24hr require
minimum of 3hrs to take effect.
• If airmovement is still poor despite maximizing
above therapy.
• 1.epineprine:0.01ml/kg SC or IM(1:1000:max
dose,0.5ml)every 15 min up to 3doses.

11. • i.bronchodilator,vasopressor and inotropic effects.
• ii.short acting (15min) and should be used as
temporizing rather than definitivetherapy.
• 2.MgSo4:25-75mg/kg/dose iv or im(max2g) infused
over20min every 4-6hr up to 3-4doses
• smooth muscle relaxant,relieves bronchospasm,C/I if
patient is in Hypotension or Renalfailure.
• Saline bolus can be given prior to administration to
avoid hypotention.

12. • 3.terbutaline:0.01mg/kg SC(max 0.4mg) every
15min upto 2doses.
• Systemic b2 agonist limited by cardiac
intolerence.
• Monitor continuous ecg,cardiac
enzymes,urine analysis,electrolytes

19. Treatment
Intermittent Asthma
• Step 1 (all ages):
• Short acting beta agonist (e.g. salbutamol)
• If symptoms greater than 2 days per week
(other than exercise induced symptoms)
patient is not well-controlled and the next step
needs to be considered

21. Long term management of asthma
• Goals:
• Maintenance of near normal physical activity.
• Maintenance of near normalpulmonary
function.
• Prevention of night time cough or wheezing
with minimal chronic symptoms.
• Prevention of exacerbation of asthma.
• Avoinding adverse effects of medication.

22. • The effective long term management of
asthma involves 3 major areas.
• Identification and elimination of exacerbating
factors.
• Drug therapy
• Parental education.

23. pharmacotherapy
• For Long term management:
• SABA:adrenaline,terbutaline,salbutamol
• LABA:salmeterol,formoterol.
• Corticosteroids:beclomethasone,budesonide,f
luticasone.

29. Assessing control
“Well-controlled” asthma
•daytime symptoms less than 2 days per week
•night awakenings secondary to asthma less than 2 times
per month
•ability to perform activities without limitations
•less than 2 steroid bursts per year
•FEV1 greater than or equal to 80% predicted
•FEV1/FVC 80% (>5 years old) and 85% (8-19 years old)
•Consider “stepping down” regimen if patient has been
well-controlled for 3 months or more consecutively and
reassess every 3-6 months
•Refer to specialist if control can’t be obtained in 3-6
months using step guidelines or if patient has 2 or more
emergency room visits or hospitalizations in 1 year