Asthma
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.
·
Hyperinflation.
·
Wheeze
and prolonged expiration.
Not needed if there has been
recent imaging. It may show:
·
Hyperinflation.
·
Flattened
hemi-diaphragms.
·
Peribronchial
cuffing.
·
Atelectasis.
·
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.
·Methylxanthines:
theophylline.
·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.
·Adrenal
suppression.
·Oral
candidiasis.
·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:
·Vomiting
·Sleep disturbance or increased
sleeping.
·Headaches.
·Poor concentration and
deterioration of performance at school.
Arrhythmias.
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2023 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.