Management of bronchial asthma in children

Management of bronchial asthma in children

• 1.
  Management of Bronchial Asthmain Children
• 2.
  Definition: Bronchial Asthma Themost 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.
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  Clinical Picture: 1. Frequentepisodes 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 animal b. exercise c. pollens d. respiratory viral infections e. exposure to tobacco smoking f. strong emotional expression
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  Alternative Causes ofrecurrent 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
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  Diagnostic Procedure: 1. CBC 2.IgE 3. Allergy Skin testing 4. Pulmonary Function Testing 5. X-ray Chest
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  Classification by Levelof 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 for reliever/rescue treatment < 2 days/week > 2 days/week > 2 days/week
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  Classification by Levelof Control: In older children, the FEV1 and PEF readings can help in assessment of control Lung function FEVI or PEF Controlled >80% predicted Partly controlled < 80% predicted Uncontrolled 60% - <80% VARIABILITY <20% 20-30% >30%
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  Management: A. Assessing AsthmaControl 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.
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  Management: Devices recommended todeliver inhaled medications for children include 1. Nebulizer 2. Pressurized metered dose inhalers pMDI 3. Spacer Devices 4. Diskus 5. Turbuhalers
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  Management:
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  Management: • Children youngerthan 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
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  Management: A. Reliever Medications -Rapid acting b2 agonists(ventolin) B. Controller medications - Inhaled glucocorticoids - Leucotriene modifiers
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  Management: C. Monitoring tomaintain 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
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  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
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  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
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