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Asthma is a disease of chronic airway inflammation, bronchial hyper-reac-tivity, and reversible airway obstruction. It affects 10% of the population and can develop at any age, but typically half of the paediatric cases pre-sent before the age of 10yrs. There is often a family history of asthma or atopic disease.
· Cough after exercise or sometimes in the early morning, disturbing sleep.
· Shortness of breath.
· Limitation in exercise performance.
In the child with chronic problems consistent findings include:
· Barrel-shaped chest.
· Wheeze and prolonged expiration.
Not needed if there has been recent imaging. It may show:
· Flattened hemi-diaphragms.
· Peribronchial cuffing.
· Peak expiratory flow rate (PEFR) <80% predicted for height.
· FEV1/FVC <80% predicted.
· Concave scooped shape in flow volume curve.
· Bronchodilator response to β-agonist therapy (i.e. 15% increase in FEV1 or PEFR).
The main medications used for maintenance are bronchodilators, which give short-term relief of symptoms, and prophylactic therapy, which reduces chronic inflammation and bronchial hyperreactivity. In the out-patient clinic our aim is to titrate these treatments so that the child can function normally, yet still avoid any detrimental effect on growth and development.
· Short-acting β2-agonists: salbutamol, terbutaline.
· Long-acting β2-agonists: salmeterol, formoterol.
Short-acting anticholinergic: ipratropium bromide.
·Inhaled steroids: budesonide, beclometasone, fluticasone.
·Oral steroids: prednisolone.
·Sodium cromoglicate: rarely used.
·Leukotriene inhibitors: montelukast and zafirlukast may reduce the amount of steroid therapy that is needed to control symptoms.
·Combination inhalers containing inhaled steroids and long-acting B2-agonists.
When long-term oral steroids or high-dose inhaled steroids are used, spe-cial attention will need to be given to unwanted effects including:
·Impaired growth: can affect growth in height, but also ask about frequency of hair-cuts, or changing shoe size, as these are early indicators of poor growth.
·Altered bone metabolism.
Now rarely used in children, but you should be aware that there are a number of problems related to toxic blood levels, including:
·Sleep disturbance or increased sleeping.
·Poor concentration and deterioration of performance at school.
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