Paediatrics: Asthma: clinic management (1)

Asthma: clinic management (1)

The aim of treatment is to allow the child to lead a normal life. In the clinic you will come across children with seemingly distinct clinical pat-terns of their chronic asthma. Patients with frequent or persistent asthma should be seen in a specialist clinic. Nebulized treatment is used in severe acute asthma. It is not recommended in mild to moderate severity asthma. Instead, use multidosing (up to 10 puffs) bronchodilator.

Infrequent episodic asthma

Characteristics

·  75% of asthmatics.

·  <4 episodes per year.

·  Symptom-free between acute episodes.

·  No regular treatment needed.

Management strategy

·  Treat acute episodes with B₂-bronchodilators.

·  Use nebulized bronchodilators and short-course prednisolone in more severe episodes (i.e. prednisolone 3 days, given once daily in the morning after breakfast with no need to taper treatment).

Frequent episodic asthma

Characteristics

·  20% of asthmatics.

·  Episodes every 2–4 weeks.

·  Regular treatment is needed.

Management strategy

·  Use B₂-bronchodilator as required.

·  Use regular, low-dose inhaled steroid.

Persistent asthma

Characteristics

·  Less than 5% of asthmatics.

·   >=3 episodes/wk, with cough at night/morning.

·  Regular treatment is needed.

Management strategy

·  Use prophylactic inhaled steroids.

·  Long-acting B₂-bronchodilator may be helpful.

·  Oral steroids may be needed.

·  Oral leukotriene inhibitors may enable reduction in steroid usage.

Exercise-induced asthma

Management strategy

·  Mild: use β₂-bronchodilator before exercise.

·  Severe: low-dose inhaled steroid.

Escalating therapy

Having reviewed the history and categorized your patient in terms of clin-ical pattern and severity, use a logical, stepwise approach to escalating therapy.