This document discusses childhood asthma, including its definition, clinical manifestations, diagnosis, and treatment. Childhood asthma is a chronic inflammatory airway disorder resulting in recurrent wheezing, coughing, and shortness of breath, especially at night or with exercise. Initial treatment for an asthma exacerbation includes inhaled bronchodilators, steroids, magnesium sulfate, and supplemental oxygen. Long-term asthma management focuses on identifying triggers, pharmacotherapy like inhaled corticosteroids and bronchodilators, and parental education. The goals of treatment are to maintain normal activity and lung function while preventing nighttime symptoms, exacerbations, and adverse medication effects.

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