2. INTRODUCTION
Most common chronic disease of childhood
Asthma is a heterogeneous disease, characterized by
chronic airway inflammation resulting in episodic
airflow obstruction.
It is defined by the history of respiratory symptoms
such as wheeze, shortness of breath, chest tightness
and cough that vary over time and in intensity,
together with variable expiratory airflow limitation.
6. CLINICAL PRESENTATION
Most common cause of chronic cough in children older than 3 years old is
asthma
Not always accompanied by wheezing
80 % of children with asthma develop symptoms before 5 years of age
Breathlessness, chest tightness, chest pressure and chest pain
Poor school performance and fatigue
7. DIAGNOSIS OF ASTHMA
• Intermittent dry coughing
• expiratory wheezing
• shortness of breath and chest tightness
• Intermittent, nonfocal chest pain.
• Respiratory symptoms can be worse at night
• Daytime symptoms, often linked with physical
activities or play.
• limitation of physical activities, general fatigue.
• Lung function tests can help to confirm the
diagnosis of asthma and to determine disease
severity.
• Spirometry is helpful as an objective measure of
airflow limitation.usually feasible in children > 6 yr of
8. DIFFERENTIAL DIAGNOSIS
Age Common Uncommon Rare
Less than
6 months
Bronchiolitis
Gastro-
esophageal
reflux
Aspiration pneumonia
Bronchopulmonary dysplasia
Congestive heart failure
Cystic fibrosis
Asthma
Foreign body aspiration
6 months -
2 years
Bronchiolitis
Foreign body
aspiration
Aspiration pneumonia
Asthma
Bronchopulmonary dysplasia
Cystic fibrosis
Gastro-esophageal reflux
Congestive heart failure
2 - 5 years Asthma
Foreign body
aspiration
Cystic fibrosis
Gastro-esophageal reflux
Viral pneumonia
Aspiration pneumonia
Bronchiolitis
Congestive heart failure
Gastro-esophageal reflux
IPAG 2007
9. ASTHMA MANAGEMENT AND PREVENTION
The goals for successful management of asthma are
•Achieve and maintain control of symptoms
•Maintain normal activity levels, including exercise
•Maintain pulmonary function as close to normal as possible
•Prevent asthma exacerbations
•Avoid adverse effects from asthma medications
•Prevent asthma mortality
10. ASTHMA TREATMENTS
Classified into Controllers and Relievers
• Controllers – medications to be taken on daily long term basis.
• Relievers – medications to be used on as-needed basis to relieve symptoms quickly.
11. TREATMENT
There are two main types of drugs used for treating asthma.
Medications to reduce bronchoconstrictions:
o Beta 2 Agonist
o Anticholinergics
o Theophylline
Medications to reduce inflammations:
o Steroids ( oral, Parenteral & Inhalers)
o Not steroids:
• Leukotriene modifiers
• Cromolyn & Nedocromil (Reduction of mast cell degranulation
12. Long-term control medications:
o Corticosteroids (mainly ICS, occasionally OCS).
o Long Acting Beta Agonists (LABA’s) including salmeterol and
formoterol,
o Leukotriene Modifiers (LTM)
o Cromolyn & Nedocromil
o Methylxanthines: (Sustained-release theophylline)
Quick- relief medications:
o Short acting Beta Agonists (SABA’s)
o Systemic corticosteroids
o Anticholinergics
13. Classifying Asthma Severity into intermittent, mild, moderate, or severe
persistent asthma depending on symptoms of impairment and risk
Once classified, use the 6 steps depending on the severity to obtain asthma
control with the lowest amount of medication
Controller medications should be considered if:
• >4 exacerbations/year,
• 2 episodes of oral steroids in 6 months, or
• use of SABA’s (salbutamol) more then twice a week
19. Asthma treatment can be administered in different ways – inhaled,
oral, or by injection.
Advantage of inhaled therapy - drugs are delivered directly into the
airways, producing higher local concentrations with significantly less
risk of systemic side effects.
Inhaled medications for asthma are available as pressurized MDIs,
DPIs, soft mist inhalers and nebulized or ‘wet’ aerosols.
CFC inhaler devices are being phased out due to the impact of
CFCs upon the atmospheric ozone layer, and are being replaced by
HFA devices.
20. CHOOSING AN INHALER DEVICE FOR CHILDREN WITH
ASTHMA
Age group Preferred device Alternative device
Younger than 4 years
Pressurized metered-dose inhaler plus
dedicated spacer with face mask
Nebulizer with face mask
4-5 years
Pressurized metered-dose inhaler plus
dedicated spacer with mouthpiece
Nebulizer with mouthpiece
Older than 6 years
Dry powder inhaler or breath actuated
pressurized metered-dose inhaler or
pressurized metered-dose inhaler with
spacer with mouthpiece
Nebulizer with mouthpiece
21. TO SUMMARIZE…
Asthma is an inflammatory illness
Diagnosis of asthma is clinical, and relies on history
All asthma does not wheeze
In children < 3 yrs, WALRI is an important differential diagnosis
2 out of 3 children outgrow their asthma
A family history of asthma / atopy increases risk of asthma
Diagnosis
22. TO SUMMARIZE…
Patient education is a very important part of asthma management
Drugs control, but do not cure asthma
Clinical grading over time, decides long term management plan
Mild intermittent asthma does not merit controllers
Inhaled steroids are mainstay of long term asthma management
Treatment should be stepped up or stepped down depending upon
patient response
Long term management
Asthma is a disease in which inflammation, narrowed airways, constricted muscles, airway hyper-reactivity and remodeling result in clinical features of cough, wheezing, shortness of breath and exercise intolerance.
