Asthma is a disease of chronic airway inflammatory, bronchial hyperreactivity and reversible airway obstruction. Can present at any age but half present before age 10. There is often a family history. There may be a history of cough after exercise or in early morning, may have disturbed sleep. Shortness of breath and limitation in exercise performance. On examination if chronic there may be barrel shaped chest, hyperinflation and wheeze with prolonged expiration.
investigations for asthma will show...
Spirometry PEFR <80% predicted for height. FEV1/FVC <80% predicted. Concave scooped shape in flow volume curve. Bronchodilator response to beta-agonist therapy (I.e. 15% increase in FEV1 or PEFR).
main asthma treatments in children are...
The main medications are bronchodilators e.g. salbutamol, salmeterol and ipratropium bromide with chronic treatment of inflammation and hyperreactivity e.g. inhaled steroids, oral steroid, methylxanthines (rarely used in children due to toxicity), leukotriene inhibitors
instruct the parent of a infant to use a spacer
If aged >3 then use inhaler with spacer and do 5 tidal breaths. If an infant then tilt the spaces of valve is open the let the infant take at least 5 breaths form each dose.
Types of asthma
• Infrequent episodic asthma: <4 episodes per year, symptom free between acute episodes, no regular treatment needed. This can be managed with treatment of acute episodes with beta2 bronchodilators. Use nebulised bronchodilators and short course prednisolone in more severe episodes.
• Frequent episodic asthma: episodes every 2-4 weeks, regular treatment is needed. Use beta2 bronchodilator as required with regular low dose inhaled steroid
• Persistent asthma: 3 or more episodes a week with cough at night or in the morning. Regular treatment is needed. Use prophylactic inhaled steroids and long acting beta2 bronchodilator may be needed. Oral steroids may be needed and oral leukotriene inhibitors may enable reduction in steroid usage.
• Exercise induces asthma: mild use a beta2 bronchodilator before exercise. If severe the use low dose inhaled steroid.
Describe the treatment for asthma and stepwise progression