1. Childhood Asthma
A Guide for Physicians and Nurses - 2013
Management of Asthma in Children
0 to 11 Years Old
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2. Childhood Asthma
2
Childhood Asthma
The Health Authority of Abu Dhabi is grateful to all Asthma Advisory
Group members for meeting the challenge in building up Asthma
Awareness program in the emirate of Abu Dhabi. The programme
main objective is to raise the health care professional awareness on
initial diagnosis and management of childhood and adult asthma.
Principle Editor
Dr. Mohammed Taleb AlSamri
Co-Editors
Dr. Abdul-Kader Souid
Dr. Anwar Sallam
Dr. Asma Al Nuaimi
Dr. Durdana Iram
Dr. Matouk Zbaeda
Dr. Nizar Khairalla
Dr. Rahat Nasim
We welcome feedback from physicians and nurse on ways to improve
and strengthen this guide. Please email comments to ncd@haad.ae
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3. 3
Childhood Asthma
Contents
Introduction ..........................................................................................4
Asthma Diagnosis.................................................................................5
Monitoring Asthma Control ..................................................................7
Asthma Management ...........................................................................7
Patient (Family) Education................................................................8
Control of Environmental Factors.....................................................8
Assessing control of asthma............................................................9
Treatment to achieve control..........................................................10
Monitoring control ..........................................................................12
Management of Acute Asthma exacerbation.................................13
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4. Childhood Asthma
4
Introduction
The Health Authority of Abu Dhabi developed this guideline for
diagnosis and management of asthma in children aged 0-11 years.
Primary care physicians should find this reference helpful in
successful asthma management.
The Guide includes recommendations that facilitate management
of asthma in children 0 to 11 years of age, such as difficulties in the
diagnosis and efficacy and safety of the drugs and their delivery
systems.
This document is developed based on guidelines from the Global
Initiative for Asthma (GINA), the National Asthma Education and
Prevention (NAEPP), British Thoracic Society and the Canadian
Thoracic Society.
This guideline will be updated periodically through the online version
on the Health Authority of Abu Dhabi website (www.haad.ae).
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5. 5
Childhood Asthma
Asthma Diagnosis
The diagnosis of asthma is established after thorough medical history
and physical examination (Table1). Assessments of airflow limitation
and bronchodilator response support the diagnosis in children >5
years of age.
Table 1. Features that increase the likelihood of asthma
Recurrent breathlessness, chest tightness, wheezing and cough
Symptoms often worse at night and early morning
Symptoms often follow respiratory infection, exercise, exposure to
aeroallergens or irritants and stress
Symptoms persist after 3 years
Symptoms improve with bronchodilator and anti-inflammatory
treatments
Absence of clear seasonal variation in symptoms
Signs of airway obstruction (e.g., retractions, nasal flaring and
prolonged expiratory phase)
Wheezing heard on auscultation
Response to adequate asthma therapy
Presence of personal and parental history of atopy (atopic dermatitis,
allergic rhino-conjunctivitis, food allergy and asthma)
Presence of other predictors, such as eosinophilia and wheezing
without colds
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6. Childhood Asthma
6
Conditions that mimic asthma (recurrent cough and wheezing) are
listed in Table 2. These entities should be considered if response to
asthma treatment is inadequate.
Spirometry and Peak Expiratory Flow
Spirometry supports the diagnosis of asthma in children >5 years of
age. Normal results in symptomatic patients do not exclude asthma.
An increase in FEV-1 of >12% (or >200 mL) from the baseline
indicates reversibility of airway obstruction.
Peak expiratory flow (PEF) is useful in monitoring the control of
asthma in children >5 years of age. An increase in PEF >20% of the
personal best is considered significant response to a bronchodilator
or a long-term use of controller therapy.
Table 2. Differential diagnosis of asthma
• Allergic rhinitis and sinusitis
• Chronic lung disease of prematurity
• Cystic fibrosis
• Foreign body aspiration
• Vascular ring
• Laryngotracheomalacia
• Immune deficiency (bronchiectasis)
• Gastroesophageal reflux
• Aspiration due to swallowing dysfunction
• Primary ciliary dyskinesia
• Congenital heart disease
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7. 7
Childhood Asthma
The goals of treatment are to achieve and maintain “control of
disease”. Physicians should assess symptoms and use of during
each visit (Table 3).
Table 3. Monitoring asthma control
Monitoring Asthma Control
Asthma Management
Goals for successful management include:
• Achieving and maintaining asthma control
• Normal physical activities, including exercise
• Maintain FEV-1 as close to normal as possible
• Prevention of asthma exacerbation
• Avoiding adverse effects of medications
• Reduced symptoms (e.g., cough, wheezing, difficulty breathing in the
day and night)
• Reduced use of short-acting ß-agonists for relieving symptoms
• Reduced exercise-induced symptoms and limitations
• Reduced exacerbations, emergency visits, systemic steroids,
admissions, and missing school.
• Patient/parents education about asthma control, inhaler technique and
written asthma action plan
• Monitoring adverse effects of medications
• Monitoring growth (height and weight)
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8. Childhood Asthma
8
Patient (Family) Education
Control of Environmental Factors
This mission aims to facilitate a self-management by providing
information and clear instructions concerning:
• Asthma principles
• Triggers (environmental factors) identification and avoidance
• Differences between “relievers” and “controllers”
• Inhaler technique
• Monitoring asthma control using symptoms and peak expiratory
flow
• Action plan (examples in pages 17-18)
• Importance of compliance with treatment
• Follow-up visits
Exposure to irritants or inhaled allergens can increase asthma
symptoms, lead to exacerbation. Inquires about indoor and outdoor
allergens and irritants are thus essential.
Decreasing environmental exposure to the following irritants is
critically important:
• Smoking
• Perfumes and burning fragrances (bakhoor)
• Sand storms and dust
• Extreme heat waves
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9. 9
Childhood Asthma
Assessing control of asthma
Children should be followed up regularly to assess their level of
control and review the treatment plan. The assessment should
include:
• Review of triggers, risk factors and concerns
• Control of symptoms
• Medication compliance
• Inhaler technique
• Spirometry and forced peak expiratory flow
A well-controlled asthma is characterized by:
• Daytime symptoms <2 times per week
• No nocturnal symptoms
• No awakening at night
• Reliever rescue treatment ≤2 per week
• Normal FEV-1
• No limitations of activities
• No school absences
• No exacerbations
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10. Childhood Asthma
10
Treatment to achieve control
Medication choices are determined by the level of control. The
delivery devices depend on age of the child. Inhaled medications are
preferred. Appropriate management relies on:
• Establishing minimum effective controlling dose
• Prescribing a reliever medication
• Selecting the most appropriate delivery device, such as
• <4 years: pMDI (pressurized metered-dose inhaler) plus spacer
with face mask
• 4-6 years: pMDI plus a spacer with mouthpiece
• >6 years: Dry powder inhaler, or pMDI, with spacer and mouth
piece
• Nebulizer if the child cannot use the above devices
Inhaled steroids should be considered for children with the following
features:
• Use of inhaled ß2-agonists ≥3 times per week
• Symptomatic ≥3 times per week or more
• Waking up one night a week
• An exacerbation of asthma requiring oral corticosteroids within
6 months
Initial preventer therapy
Low-dose inhaled steroid
Leukotriene receptor antagonists (LTRAs) are second-line
preventer
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11. 11
Childhood Asthma
Intermittent
asthma*
Step 1
(as needed reliever
medication)
First choice 1
Short (rapid)-acting -agonist
Persistent
asthma**
Step 2
(reliever medication
+ single controller)
First choice 2
Low daily dose inhaled corticosteroid
Alternative 3
Anti-leukotrienes
Step 3
(reliever medication
+ ≤2 controllers)
First choice
Low daily dose inhaled corticosteroid
+ 4
long-acting -agonist
Alternatives
2
Medium or high daily dose inhaled
corticosteroid
OR
Low daily dose inhaled corticosteroid
+ montelukast
Step 4
(reliever medication
+ ≥2 controllers)
First choice
Medium or high daily dose inhaled
corticosteroid + long-acting -agonist
Alternatives
Medium or high daily dose inhaled
corticosteroid + montelukast
OR
Medium or high daily dose inhaled
corticosteroid + 3
theophylline
Step 5
(reliever medication
+ additional controller
options)
First choice
Step 4 + systemic corticosteroid
± 5
anti-IgE treatment (omalizumab)
* Symptoms occurring <2 days/week, <2 nocturnal awakening/month, use of short-acting ß-agonists <2 days/week, normal activity and
normal PEF or FEV-1.
** Not meeting the criteria for “intermittent asthma”.
1
Treatment of choice for acute exacerbation; onset of action is within ~30 min, which could last for up to 4 hr. It is typically given on
“prn” basis. Increased use is a sign of poor asthma control and a need for reassessment.
2
Inhaled corticosteroids are essential for management of persistent asthma. Low fluticasone or beclomethasone dose corresponds
to 100-250 μg/day, medium dose >250-500 μg/day, and high dose >500-1000 μg/day. The corresponding doses for budesonide are
200-400 μg/day, >400-800 μg/day and >800-1600 μg/day, respectively.
3
Less effective than long-acting inhaled ß-agonists or inhaled corticosteroids.
4
Long-acting inhaled ß-agonists should not be used as monotherapy; most effective when combined with inhaled corticosteroid.
5
Considered for known sensitization to allergens and high IgE level
Add-on therapy options
Long-acting ß2-agonists for children >4 years
Medium-dose or high-dose inhaled steroid
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12. Childhood Asthma
12
Monitoring control
Clinical benefits of the preventer medication start within days of
initiating treatment. The maximum benefit is established within 3
months. Once the patient is started on a preventer treatment, follow
up appointments should be set as follows:
• Every 1-3 months if using a controller medication
• More frequently if not well controlled
• Within 3 days of exacerbation, then in 4 weeks
When to adjust treatment?
The treatment is adjusted after 3 months.
• If not controlled within 1-3 months, patients should be reassessed
and medications should be adjusted
• If well controlled for 3 months, decrease the medication
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13. 13
Childhood Asthma
Management of acute asthma
exacerbation
Asthma Severity Mild Moderate Severe
Respiratory Rate
per min
2–3 years
4–5 years
6–12 years
>12 years
27–34
25–30
21–26
19–23
35–39
31–35
27–30
24–27
≥40
≥36
≥31
≥28
Oxygen Saturation
(SpO2)
95% to 97% on
room air
90% to 94% on
room air
<90% on room air or on
any oxygen
Auscultation
End expiratory
wheezes only
Expiratory
wheezing
Inspiratory and expiratory
wheezing to diminished
breath sounds
Retractions Intercostal
Intercostal &
substernal
Intercostal, substernal
and supraclavicular
Dyspnea
Speaks in short
sentences, coos
and babbles
Speaks in partial
sentences, short
cry
Speaks in single words.
Short phrases/grunting
Assessment of severity of asthma determines its treatment (Table)
Oxygen
• Children with SpO2 <92% or with life threatening asthma should
receive high flow oxygen via a partial or non-rebreather mask to
maintain SpO2 >95%
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14. Childhood Asthma
14
Mild asthma exacerbation:
• Short acting ß2 agonists: Salbutamol, pMDI+spacer is the
preferred option
• Children <3yr: require face mask
• 5-10 puffs of salbutamol (100 μg/puff) repeated every 10-20 min
according to clinical response
Moderate or Severe asthma exacerbation
• High flow oxygen via a partial or non-rebreather mask to maintain
SpO2 >95%.
• Salbutamol (nebulized)
• Dose: 2.5 mg <30 kg and 5 mg >30 kg. Every 20 minutes for
3 doses then every 1–4 hours as needed.
• Continuous salbutamol nebulization is needed if respiratory
failure is impending.
• The patient must be reassessed every 10 min
• Ipratropium bromide(nebulized)
• Dose: 500 μg to be given in conjunction with salbutamol for the
first 2 hours, and then continue nebulized every 6 hours
• Corticosteroid
• Prednisolone, 1 mg/kg once/day
• If not tolerated, give IV hydrocortisone, 4 mg/kg q 6 h
(maximum 100 mg/dose) or methylprednisolone 1 mg/kg every
6 h (maximum 60 mg/day).
• IV fluid
• D5W 0.45% NaCl at 75% of maintenance
If patient is not responding to the above treatment, consider the
following:
• Magnesium sulphate (MgSO4)
• 50 mg/kg IV loading infusion over 20 minutes (maximum 2000 mg)
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15. 15
Childhood Asthma
• Magnesium should be diluted to a ≤20% solution (e.g., 20 mL
MgSO4 + 80 mL 0.9% NaCl)
• Assess for response and consider MgSO4 infusion
• Aminophylline
• 5 mg/kg IV loading dose is given over 20 min, unless patient is
on maintenance theophylline
• Assess for response and consider continuous infusion at
1 mg/kg/hr
• IV Salbutamol
• Bolus dose 15 mcg/kg over 10 min
• Assess for response and consider continuous infusion at
1-2 μg/kg/min. This should be administered in intensive care
setting
• Mechanical ventilation
• If patient continue to deteriorate despite the above
interventions, consider respiratory support
Investigation:
• Indications for chest x-ray
• Severe life threatening asthma
• Suspected pneumothorax or consolidation
• Failure to respond to treatment
• Atypical presentation
• Blood investigation:
• Blood gases
Arterial sample is indicated in ventilated patients
Venous gas for severe patients
• CBC, blood culture and CRP indicated in severe exacerbation
or where antibiotics are indicated
• Electrolytes for severe asthma
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16. Childhood Asthma
16
Specialty Referral
• Life-threatening asthma
• Patient on high-dose inhaled corticosteroids, fluticasone
>250 μg/day or equivalent
• Poor control despite appropriate management
• Diagnosis is uncertain
• Requires >4 oral corticosteroids in 1 year
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17. 17
Childhood Asthma
Patient’s
Sticker
‫ﺍﻟﻌﻼﺟﻴﺔ‬ ‫ﺍﻟﺮﺑﻮ‬ ‫ﺧﻄﺔ‬
‫ﺍﻟﻌﻤﺮ‬ ‫ﻣﻦ‬ ‫ﺍﻟﺨﺎﻣﺴﺔ‬ ‫ﺍﻟﺴﻨﺔ‬ ‫ﻣﻦ‬ ‫ﺍﻻﻗﻞ‬ ‫ﻟﻼﻃﻔﺎﻝ‬
‫ﺍﻟﻴﻮﻣﻲ‬ ‫ﺍﻟﺪﻭﺍء‬ ‫ﺟﺪﻭﻝ‬
‫ﺍﻟﺪﻭﺍء‬ ‫ﺇﻋﻄﺎء‬ ‫ﺍﻭﻗﺎﺕ‬ ‫ﺍﻟﺠﺮﻋﺔ‬ ‫ﺇﻋﻄﺎء‬ ‫ﻃﺮﻳﻘﺔ‬ ‫ﺍﻟﺪﻭﺍء‬ ‫ﺇﺳﻢ‬
*
**
‫ﺍﻟﻌﻼﺟﻴﺔ‬ ‫ﺍﻟﺨﻄﺔ‬
‫ﺷﻜﻮﻯ‬ ‫ﻻ‬‫ﺍﻷﺧﻀﺮ‬ ‫ﺍﻟﻤﺠﺎﻝ‬
•.‫ﺍﻟﺴﻴﻄﺮﺓ‬ ‫ﺗﺤﺖ‬ ‫ﺍﻟﺮﺑﻮ‬
•.‫ﺍﻟﻴﻮﻣﻲ‬ ‫ﺍﻟﺪﻭﺍء‬ ‫ﺟﺪﻭﻝ‬ ‫ﺇﺗﺒﻊ‬
•.‫ﺍﻷﺯﻣﺎﺕ‬ ‫ﺩﻭﺍء‬ ‫ﻹﺳﺘﺨﺪﺍﻡ‬ ‫ﺣﺎﺟﺔ‬ ‫ﻻ‬
‫ﺧﻔﻴﻔﺔ‬ ‫ﺃﻋﺮﺍﺽ‬
.‫ﺻﻔﻴﺮ‬ ‫ﺍﻭ‬ (‫)ﻛﺤﺔ‬ ‫ﺳﻌﺎﻝ‬
.‫ﺍﻟﺼﺪﺭ‬ ‫ﻓﻲ‬ ‫ﺿﻴﻖ‬
.‫ﺍﻟﻠﻴﻞ‬ ‫ﻓﻲ‬ ‫ﺇﺳﺘﻴﻘﺎﻅ‬
.‫ﺍﻟﺘﻨﻔﺲ‬ ‫ﻓﻲ‬ ‫ﺻﻌﻮﺑﺔ‬
‫ﺍﻷﺻﻔﺮ‬ ‫ﺍﻟﻤﺠﺎﻝ‬
•.‫ﺍﻻﺯﻣﺎﺕ‬ ‫ﺩﻭﺍء‬ ‫ﺗﻨﺎﻭﻝ‬
•.‫ﺍﻷﻋﺮﺍﺽ‬ ‫ﺗﻘﻴﻴﻢ‬ ‫ﺃﻋﺪ‬ ‫ﺛﻢ‬ ‫ﺩﻗﻴﻘﺔ‬ 15 ‫ﻣﺪﺓ‬ ‫ﺇﻧﺘﻈﺮ‬
•.‫ﺍﻟﻠﺰﻭﻡ‬ ‫ﻋﻨﺪ‬ ‫ﺳﺎﻋﺎﺕ‬ 4-6 ‫ﻛﻞ‬ ‫ﺍﻷﺯﻣﺎﺕ‬ ‫ﺩﻭﺍء‬ ‫ﺧﺬ‬
•‫ﺍﻟﻮﻗﺎﺋﻲ‬ ‫ﺍﻟﺪﻭﺍء‬ ‫ﺟﺮﻋﺔ‬ ‫ﺿﺎﻋﻒ‬ ،‫ﻭﺍﺣﺪ‬ ‫ﻳﻮﻡ‬ ‫ﺧﻼﻝ‬ ‫ﺍﻟﺨﻀﺮ‬ ‫ﺍﻟﻤﺠﺎﻝ‬ ‫ﺍﻟﻰ‬ ‫ﻳﻌﺪ‬ ‫ﻟﻢ‬ ‫ﺇﺫ‬
.‫ﺳﺎﻋﺎﺕ‬ 6-4 ‫ﻛﻞ‬ ‫ﺍﻻﺯﻣﺎﺕ‬ ‫ﺩﻭﺍء‬ ‫ﺇﺳﺘﺨﺪﺍﻡ‬ ‫ﻭﺗﺎﺑﻊ‬ ‫ﺍﻳﺎﻡ‬ ‫ﺧﻤﺴﺔ‬ ‫ﻟﻤﺪﺓ‬ (____________)
•. ‫ﺍﻻﺟﻬﺎﺩ‬ ‫ﺗﺠﻨﺐ‬ ‫ﻣﻊ‬ ‫ﺍﻟﻤﺪﺭﺳﺔ‬ ‫ﺍﻟﻰ‬ ‫ﺍﻟﺬﻫﺎﺏ‬ ‫ﻳﻤﻜﻦ‬
•.‫ﺍﻻﻋﺮﺍﺽ‬ ‫ﺯﻭﺍﻝ‬ ‫ﻋﻨﺪ‬ ‫ﺍﻟﻴﻮﻣﻲ‬ ‫ﺍﻟﺪﻭﺍﺋﻲ‬ ‫ﺍﻟﺒﺮﻧﺎﻣﺞ‬ ‫ﺍﻟﻰ‬ ‫ﺍﺭﺟﻊ‬
•.‫ﺍﻟﻌﻼﺟﻴﺔ‬ ‫ﺍﻟﺨﻄﺔ‬ ‫ﺍﺗﺒﺎﻉ‬ ‫ﺃﻳﺎﻣﻤﻦ‬ ‫ﺛﻼﺛﺔ‬ ‫ﺑﻌﺪ‬ ‫ﺍﻻﺧﻀﺮ‬ ‫ﺍﻟﻤﺠﺎﻝ‬ ‫ﺍﻟﻰ‬ ‫ﻳﻌﺪ‬ ‫ﻟﻢ‬ ‫ﺍﺫﺍ‬ ‫ﺑﻻﻌﻴﺎﺩﺓ‬ ‫ﺍﺗﺼﻞ‬
‫ﺍﻟﺸﺪﺓ‬ ‫ﻣﺘﻮﺳﻄﺔ‬ ‫ﺃﻋﺮﺍﺽ‬
.‫ﻣﺴﺘﻤﺮ‬ (‫)ﻛﺤﺔ‬ ‫ﺳﻌﺎﻝ‬
.‫ﺍﻟﻠﻴﻞ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻨﻮﻡ‬ ‫ﺇﻣﻜﺎﻧﻴﺔ‬ ‫ﻋﺪﻡ‬
.ً‫ﺳﻮءﺍ‬ ‫ﺍﻻﻋﺮﺍﺽ‬ ‫ﺇﺯﺩﻳﺎﺩ‬
.‫ﺍﻟﻴﻮﻣﻴﺔ‬ ‫ﺍﻻﻋﻤﺎﻝ‬ ‫ﻣﻤﺎﺭﺳﺔ‬ ‫ﻣﻦ‬ ‫ﺍﻟﺘﻤﻜﻦ‬ ‫ﻋﺪﻡ‬
‫ﺍﻟﺒﺮﺗﻘﻻﻲ‬ ‫ﺍﻟﻤﺠﺎﻝ‬
•.‫ﺍﻟﺪﻭﺍﺋﻲ‬ ‫ﺍﻟﻌﻼﺝ‬ ‫ﻣﻀﺎﻋﻔﺔ‬ ‫ﻓﻲ‬ ‫ﺍﺳﺘﻤﺮ‬
•.‫ﺍﻟﺤﺎﺟﺔ‬ ‫ﺣﺴﺐ‬ ‫ﺳﺎﻋﺎﺕ‬ 4-2 ‫ﻛﻞ‬ ‫ﺍﻻﺯﻣﺎﺕ‬ ‫ﺩﻭﺍء‬ ‫ﺍﺧﺬ‬ ‫ﻓﻲ‬ ‫ﺍﺳﺘﻤﺮ‬
•.‫ﻟﻠﻤﺪﺭﺳﺔ‬ ‫ﺍﻟﺬﻫﺎﺏ‬ ‫ﻋﺪﻡ‬ ‫ﻳﺠﺐ‬
•.‫ﺍﻟﻜﻮﺭﺗﻴﺰﻭﻥ‬ ‫ﺑﺘﻨﺎﻭﻝ‬ ‫ﺍﻟﺒﺪء‬ ‫ﻗﺒﻞ‬ ____________ ‫ﺑﻻﻌﻴﺎﺩﺓ‬ ‫ﺍﺗﺼﻞ‬
‫ﺷﺪﻳﺪﺓ‬ ‫ﺃﻋﺮﺍﺽ‬
.‫ﺍﻟﻤﺸﻲ‬ ‫ﺍﻭ‬ ‫ﺍﻟﻜﻼﻡ‬ ‫ﻓﻲ‬ ‫ﺻﻌﻮﺑﺔ‬
.‫ﺍﻟﺸﻔﺎﻩ‬ ‫ﺇﺯﺭﻗﺎﻕ‬
.‫ﺻﻔﻴﺮ‬ ‫ﺗﺴﻤﻊ‬ ‫ﻻ‬ ‫ﻗﺪ‬ ‫ﺍﻟﻤﺮﺣﻠﺔ‬ ‫ﻫﺬﻩ‬ ‫ﻓﻲ‬
‫ﺍﻷﺣﻤﺮ‬ ‫ﺍﻟﻤﺠﺎﻝ‬
•.‫ﺩﻗﻴﻘﺔ‬ 20-10 ‫ﺧﻼﻝ‬ ‫ﺍﻟﺘﻘﻴﻴﻴﻢ‬ ‫ﻭﺃﻋﺪ‬ ‫ﺍﻷﺯﻣﺎﺕ‬ ‫ﺩﻭﺍء‬ ‫ﺧﺬ‬
•‫ﻃﻔﻠﻚ‬ ‫ﺧﺬ‬ ‫ﺃﻭ‬ (999) ‫ﺑﻻﻄﻮﺍﺭﺉ‬ ً‫ﻣﺒﺎﺷﺮﺓ‬ ‫ﺇﺗﺼﻞ‬ ،‫ﺍﻷﺣﻤﺮ‬ ‫ﺍﻟﻤﺠﺎﻝ‬ ‫ﻓﻲ‬ ‫ﺯﺍﻝ‬ ‫ﻣﺎ‬ ‫ﺇﺫﺍ‬
.‫ﻣﺴﺘﺸﻔﻰ‬ ‫ﺍﻗﺮﺏ‬ ‫ﺍﻟﻰ‬
(‫ﺍﻟﺮﻳﺎﺿﺔ‬ ‫ﻣﻦ‬ ‫ﺩﻗﺎﺋﻖ‬ ‫ﻋﺸﺮﺓ‬ ‫ﻗﺒﻞ‬ ‫ﺗﻨﺎﻭﻟﻪ‬ ‫)ﻳﻤﻜﻦ‬ ‫ﺍﻻﺯﻣﺎﺕ‬ ‫*ﺩﻭﺍء‬
(‫ﺍﻟﺪﻭﺍء‬ ‫ﻫﺬﺍ‬ ‫ﺇﺳﺘﺨﺪﺍﻡ‬ ‫ﺑﻌﺪ‬ ‫ﺍﻟﻔﻢ‬ ‫ﻧﻈﻒ‬ ‫ﺍﻭ‬ ‫ﺍﻟﻮﺟﻪ‬ ‫)ﺇﻏﺴﻞ‬ ‫ﺍﻟﻮﻗﺎﺋﻲ‬ ‫**ﺍﻟﺪﻭﺍء‬
GSKEDC-MENA-2013-283_D7_Highres.indd 17 8/29/2013 12:42:09 PM

18. Childhood Asthma
18
ASTHMA MANAGEMENT PLAN
For children under 5 years
DAILY MEDICATION SCHEDULE
Medication Dose Delivery Method Treatment Times
*
**
* Rescue Medication (may take 10 minutes before exercise)
** Control Medication (wash face or rinse mouth after taking this medication)
ACTION PLAN
No Symptoms
Green
Zone
• Asthma under good control.
• Follow daily medication schedule.
• Rescue medication not needed.
Mild Symptoms
Coughing or wheezing
Tight feeling in chest
Waking at night
Feeling short of breath
Yellow
Zone
• Take rescue medicine (______________________)
• Wait 15 minutes and recheck symptoms.
• Use rescue medications every 4-6 hrs, if needed
• If not in green zone after needing rescue medicine for one day,
double/start your controller medicine (____________________)
for 5 days and continue rescue medication every 4-6 hours.
• Can go to school but should not play hard
• Return to daily medication schedule when symptoms are gone.
• Call office if not in green zone after following action plan for
________ days.
Moderate Symptoms
Constant coughing
Unable to sleep at night
Symptoms becoming worse
Unable to do daily activities
Orange
Zone
• Continue doubling control medicine.
• Continue taking rescue medicines every 2-4 hours, as needed.
• Should not go to school
• Call Dr.’s office @ ____________ before starting oral steroids.
Severe Symptoms
Difficulty talking, walking
Lips may appear blue
Wheezing may be absent
Red
Zone
• Take your rescue medicine.
• If still in red zone IMMEDIATELY call 999 or seek
emergency care.
Paatient’s
SSticker
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19. 19
Childhood Asthma
References
1. Global Strategy For asthma Management and Prevention,
Updated 2010. 2010 Global Initiative for Asthma.
2. Global Strategy for the Diagnosis and Management of Asthma in
Children 5 Years and Younger. Available at www.ginasthma.org.
2010 Medical Communication Resources, Inc.
3. Pocket Guide for Asthma Management and Prevention in Children
5 Years and Younger. A pocket Guide for Physicians and Nurses
2009. Available from www.ginasthma.org.
www.us-health-network.com.
4. Pocket Guide for Asthma Management and Prevention (for Adults
and Children Older than 5 Years). A pocket Guide for Physicians
and nurses Up dated 2010. Global Initiative for Asthma.
www.ginasthma.org.
5. Canadian Thoracic Society Asthma Management Continuum –
2010 Consensus Summary for Children six years of age and over,
and adults. Can Respir J Vol 17 No 1 January/February 2010.
6. Expert panel Report 3: Guidelines for the Diagnosis and
Management of Asthma. Full Report 2007.U.S.Department of
Health and Human Service, National Institute of Health. National
Heart, Lung, and Blood Institute. www.nhlbi.nih.gov/guidelines/
asthma/asthgdln.pdf.
7. British Guideline on the Management of Asthma. A national clinical
guideline. May 2008. Revised May 2011. British Thoracic Society
www.brit-thoracic.org.uk.
GSKEDC-MENA-2013-283_D7_Highres.indd 19 8/29/2013 12:42:14 PM

20. Health Authority Abu Dhabi
To download asthma pamphlets, please go to:
http://www.haad.ae
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