management of bronchial asthma in children
DESCRIPTION
Management of Bronchial Asthma in ChildrenTRANSCRIPT
Management of Bronchial Asthma in Children
Definition: Bronchial Asthma
The most common chronic disease of childhood . It is a chronic inflammatory disorder of the airways.
Chronically inflammed airways are hyper-responsive when exposed to various triggers.
Clinical Picture:
1. Frequent episodes of cough and /or wheezing
2. Activity-induced cough or wheeze
3. Cough particularly at night
4. Symptoms occur or worsen in the presence triggers such as;
a. house dust mite or companion animalb. exercise c. pollensd. respiratory viral infectionse. exposure to tobacco smokingf. strong emotional expression
Alternative Causes of recurrent Wheezing:
1. recurrent viral infections
2. chronic rhino sinusitis
3. congenital heart disease
4. GERD
5. congenital malformation causing airway narrowing
6. foreign body inhalation
Diagnostic Procedure:
1. CBC
2. IgE
3. Allergy Skin testing
4. Pulmonary Function Testing
5. X-ray Chest
Classification by Level of Control:Levels of asthma control in children 5 years and younger
Charachteristic Controlled Partly controlled Uncontrolled.
Daytime symptoms: wheezing cough difficult breathing
None.
Less than twice/week, typically for short periods ,rapidly relieved by the use of rapid acting bronchodilator
More than twice/week,typically for short periods ,rapidly relieved by the use of rapid acting bronchodilator
More than twice/week, typically last minutes or hours , recur, partially or fully relieved with rapid acting bronchodilator
Limitation of activities None.
Child is fully active ,plays and runs without symptoms
Any.
May cough, wheeze or have difficulty breathing during exercise vigorous play or laughing
Any.
May cough, wheeze or have difficulty breathing during exercise vigorous play or laughing
Nocturnal symptoms/ awakening
None.
No nocturnal coughing during sleep
Any.
Typically coughs during sleep or wakes with cough, wheezing,and/or difficult breathing
Any.
Typically coughs during sleep or wakes with cough, wheezing,and/or difficult breathing
Need forreliever/rescue treatment
< 2 days/week > 2 days/week > 2 days/week
Classification by Level of Control:
In older children, the FEV1 and PEF readings can help in assessment of control
Lung functionFEVI or PEF
Controlled>80% predicted
Partly controlled< 80% predicted
Uncontrolled60% - <80%
VARIABILITY <20% 20-30% >30%
Management:
A. Assessing Asthma Control
Each patient should be assessed to establish:-
1. Current treatment regimen
2. Adherence to current regimen and level of asthma control
3. Current impairment (day and night symptoms, activity level impairment, need for rescue medications)
B. Treatment to Achieve Control
Inhaled Medications are preferred because they deliver drugs directly to the airways where they are needed, resulting in
therapeutic effect with fewer systemic side effects.
Management:
Devices recommended to deliver inhaled medications for children include
1. Nebulizer
2. Pressurized metered dose inhalers pMDI
3. Spacer Devices
4. Diskus
5. Turbuhalers
Management:
Management:
• Children younger than 4 years of age, should use pMDI plus a spacer with a face mask or a nebulizer with a face mask.
• Children aged 4-5 years can use a spacer with mouthpiece .
• Older children can use discus device or if necessary a nebulizer with face mask.
• Among young children inhaler technique may be poor and should be monitored closely.
• Teach family members how to use the specific inhaler device
Management:
A. Reliever Medications
- Rapid acting b2 agonists(ventolin)
B. Controller medications
- Inhaled glucocorticoids
- Leucotriene modifiers
Management:
C. Monitoring to maintain Control
Patients should be seen 1-3 months after the initial visit , and every 3 months thereafter , after an exacerbation, follow up should be offered within 2 weeks.
Teach the family how to monitor control with PFM measurements
Productive Clinic Visit:
1. Family and patient education
2. Explain basic facts about asthma, environmental control
3. Teach, demonstrate, and have patient show proper technique for inhaled medication use peak flow measures.
4. Written two- part asthma management plan
5. Regular follow-up visits: monitor lung functions annually
ACUTE EXACERBATION MANAGEMENT:
A. Clinical Assessment
• Vital Signs, breathlessness, use of accessory muscles, retractions, alteration in mental status
• Pulse Oximetry
• Lung function
B. Treatment
1. Oxygen – mask or nasal cannula – Monitor Oxygen saturation to maintain > 92%
2. Inhaled short-acting B-agonists – Ventolin nebulizer
3. Systemic Corticosteroid
- Hydrocortisone
- Methyl Prednisone
4. Anticholinergics
- Atrovent
THANK YOU.