This document provides guidance on diagnosing and managing asthma in children under 5 years old. It identifies key risk factors for asthma like family history and environmental exposures. The main steps of asthma management include identifying asthma using symptoms, assessing control, and treating with a stepped approach of inhaled corticosteroids. Locally made plastic bottle spacers can effectively deliver inhaled medications to young children when commercial spacers are unavailable.

1. Diagnosis and management of
asthma in children under the
age of five years

2. Learning objective
• Identifying asthma in children
• Prenatal risk factors of asthma
• Algorithm in identifying asthma in under five years of
age child at PHC and General Hospital
• Steps Asthma Management
• Assessing asthma control in preschool children
• Preparing locally made spacer out of plastic bottles
bottle
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3. What is asthma in preschool children ?
• Wheezing or coughing that occurs with exercise,
laughing or crying, and symptoms in the absence of
apparent respiratory infection
• History of other allergic disease (eczema or allergic
rhinitis), allergen sensitization or asthma in first-degree
relatives
• Clinical improvement during 2–3 months of controller
treatment, and worsening after cessation
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4. Prenatal Risk factors for Asthma
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• Family history of atopic disease
• Maternal smoking and asthma
• Environmental pollution (especially tobacco smoke and
indoor biomass exposure),
• Nutrition
• Maternal stress
• Use of antibiotics
• Birth by caesarean section

5. Sources: ISAAC Publications

6. Impact of asthma
• Uncontrolled asthma is associated with
• missed school days
• repeated hospitalization
• risk of airway remodeling
• general poor quality of life in the affected children
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9. Steps Asthma Management
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10. Pharmacologic management
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11. Low, medium and high ICS doses: children 6-11
years
GINA 2020, Box 3-6B
DPI: dry powder inhaler; HFA: hydrofluoroalkane propellant; pMDI: pressurized metered dose inhaler (non-CFC); * see product information
This is NOT a table of equivalence. These are suggested total daily doses for the
‘low’, ‘medium’ and ‘high’ dose treatment options with different ICS.
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12. Low, medium and high ICS doses: children
5 years and younger
GINA 2020, Box 3-6B
This is NOT a table of equivalence. These are suggested total daily doses for the
‘low’ dose treatment options with different ICS.
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BDP: beclometasone dipropionate; DPI: dry powder inhaler; HFA: hydrofluoroalkane propellant; pMDI: pressurized metered dose
inhaler (non-CFC)

13. Assessing asthma control in preschool children
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14. …Cont
Watch patients inhaler
technique, check adherence .
Remove potential risk
factors : Assess and
manage risk factors
Refer to specialist for
confirmation of asthma
If asthma is confirmed
escalate the steps of
treatment
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15. Inhalation technique for preschool children
• Use spacers with face mask, in all
children less than five years of age
• Locally prepared plastic bottle based
spacers can be used.
• Clean the spacers with detergents without
rinsing it at least every 2 weeks.
• Tight seal should be created between
mask and face during inhalation and
cleaning face
• Mouth rinse after steroid administration
should be practiced regularly
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16. Constructing locally made spacers
1.Wash the bottle with soap and water and air dry
for a minimum of 12 hours to reduce electrostatic
charge on the interior plastic.
2.Make a wire mould similar in size and shape to
the mouthpiece of the MDI.
3.Heat the mould and hold in position on the
outside of the base of the plastic bottle until the
plastic begins to melt (~10 seconds). Rotate the
mould 180% and reapply to the bottle until the
mould melts through to make a hole.
4.While the bottle is still warm, insert the MDI into
the hole to ensure a tight fit between the MDI
and bottle spacer.
Prime initially with 10 puffs of
the medicine to reduce
electrostatic charge on the walls
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17. Summary
• Asthma in under five children is recognized using
symptoms rather than lung function tests.
• Genetics, environmental , perinatal risk factors are
identified .
• Inhaled corticosteroids are the backbone of asthma
management in under five years of age
• Locally made spacer is effective in delivering inhaled
drugs for asthma symptom control .
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18. •We would like to thank
• Dr. Rahel Argaw, Dr Hanan Yusuf, Dr Tewodros
Haile and Dr Amsalu Bekele for preparing this
powerpoint