SIGN AND AND SYMPTOMS , SEVERITY OF ASTHMA AND TREATMENT OF ASTHMA IN PAEDIATRICS

1. PAEDIATRIC ASTHMA
DR ATIQUR RAHMAN KHAN
MBBS,MD,DCH
Senior Paediatrician

2. Definition Of Bronchial Asthma
Asthma is chronic
inflammatory disorder of the
airways with reversible
obstruction

3. TYPES OF ASTHMA
NATURAL COURSE OF DISEASE:;
1)Recurrent wheezing in early childhood,usually
triggered by common respiratory viral infection and
resolves during the preschool years and there is less
asthma risk is later life
2)Chronic asthma ,Associated with allergy that
persist into later childhood and offen adulthood

4. According to disease severity.
Intermittent or Persistent(mild ,moderate and severe)
According to the control
Well ,not well, or very poorly control
According to treatment response
Easy to treat, well controlled with low levels of
controller therapy
Difficult to treat, well controlled with high levels of
controller therapy.

5. Exacerbators, despite being well controlled continue
to have severe exacerbations.
Refractory Asthma,continue to have poorly controlled
asthma despite multiple and high levels of controller
therapies

6. Lung Function Test
PEF :-used to monitoring airflow obstruction
Normal more than 80%, Mild less than 70% Moderate
40-69% and Severe less the 40%,
FEV1 : FVC :-less than 0.8 indicate significant airflow
obstruction
Spirometry:- used to access the airflow limitation in
patient who are at risk of severe asthma exacerbation

7. Factors contributing to asthma severity
Tobacco smoke
Animal danders,pets
Pests(mice rats)
Dust mites
Cockroaches
Wood or coal burning smoke
Strong chemical odours and perfumes
Dust

8. DEFINITION OF STATUS ASTHMATICUS
Severe exacerbation of asthma that does not
improve with standard therapy is termed
status asthmaticus.
Airflow obstruction during exacerbation can
become extensive resulting in life
threatening respiratory insufficiency.

9. Management
Risk assessment at the time of presentation
● Onset of current exacerbation
● Frequency and severity of night and day time
● symptoms and activity limitation
● Frequency of rescue bronchodilators used
● Potential triggers
● History of systemic steroids courses,
● Emergency department visits,hospitalization,
● Intubation or life threatening episode.

10. Clinical Assessment
● Physical examination finding:- vitals sign,
breathlessness, tachypnea retraction,use of
accessory muscles of respiration,anxiety level,
altered level of consciousness,unable to talk in
sentences,Irritable ,exhausted,
● Pulse oximetry
● Lung function should be deferred in patient of
moderate to severe asthma

11. Work up
CBC, RBS, Electrolytes
Chest X ray
PEF.

12. Medical Management
O2 with mask/nasal prongs to keep saturation more than 92 %
Use of short acting B agonist
Salbutamol Nebulization (0.15-0.3 mg /kg) every 20 min for 1 Hr Or
0.5 mg/Hr continuous nebulization
Steroids (Oral /IV)
1)Methylprednisolone 1-2 mg/kg/day BD (Max 60mg)
2)Inj Dexamethasone single(oral/IV/IM) 0.6mg/kg,Max 16 mg,
has been found to be an effective alternative to prednisone and
with low incidence of emesis

13. Prednisolone:-(syp/tab) 0.5-1 mg BID
Max 60mg/day
Inj Hydrocortisone:- Loading dose 4-8 mg/kg/dose
Maintenance 8 mg/kg/24 hrs

14. Anticholinergic drugs
Ipratropium Bromide/ Atrovent Nebulization
0.25mg If age less then 12 yrs
0.5 mg if more then 12 yrs Q6-8H
When use in combination with salbutamol,
Ipratropium can improve lung function and reduce
rate of hospitation due synergistic effect.

15. Injectable Sympathomimetic(Adrenaline)
0.01mg/kg Max 0.5 mg SC/IM
May repeat after 15 to 30 mins
After all this treatment we have to evaluate
whether patient will be admitted to ward or
ICU

16. Indication for ICU admission
1)Altered sensorium
2)Use of continuous B2 agonist
3)Marked decreased air entry
4)Rising PC02
5)Exhaustion
6)Severe respiratory distress with possibility of
respiratory failure

17. According to latest concept every effort
should be made to relieve bronchospasm and
prevent respiratory failure in order to avoid
mechanical ventilation.
If at all necessary, elective intubation with
sedation (paralytic agent -Ketamine) is safer
than emergency intubation.

18. If patient is shifted to ICU/Ward and still not
improved
Magnesium Sulphate 25 -75 mg/kg over 20 min
Max 2.5 Gm.
Administration of Magnesium Sulphate needs
monitoring of Serum levels and cardiovascular status

19. Inj Terbutaline:-Continuous IV infusion 2-10 microgram/kg
loading dose,followed by 0.1-0.4 microgram/min
We can increase the dose 0.1-0.2 microgram/kg/min depending on
the clinical response
Terbutaline Infusion also needs cardiorespiratory monitoring,Pulse
Oximetry ,Blood pressure.
Adverse Effects:-
Tremors,Tachycardia,Palpitation,Arrhythmia,Hypertension,
Headache,Nausea,Vomiting.

20. If after all this medical
management patient is still in
respiratory distress and clinically
deteriorating then elective
intubation is preferred

21. Criteria for Intubation
Apnea / Respiratory Arrest
Decrease level of Consciousness
Impending respiratory failure
Significant rising Pco2 and fatigue

22. Mechanical Ventilator Parameter
In Asthmatic patients, mechanical Ventilation aims to
achieve adequate oxygenation while tolerating mild to
moderate hypercapnia (50-70 mmHg) to minimize
barotrauma
Volume cycled ventilators, using short inspiratory and
long expiratory time(I:E 1:3) ,with low PEEP
Tidal Volume 6-10 ml/kg
Ventilator Rate according to age.

23. Thanks