Asthma is a disease of chronic airway inflammation, bronchial hyper-reactivity, and reversible airway obstruction.
Asthma is a disease of chronic airway inflammation, bronchial hyper-reactivity, and reversible airway obstruction. It affects 10% of the population and can develop at any age, but typically half of the paediatric cases present 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 the flow-volume curve.
- Bronchodilator response to β-agonist therapy (i.e. 15% increase in FEV1or 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.
Chronic treatment of inflammation and hyperreactivity
- 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.
Side-effects of chronic treatment
When long-term oral steroids or high-dose inhaled steroids are used, special attention will need to be given to unwanted effects including:
- Impaired growth: can affect growth in height, but also ask about the frequency of haircuts, 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:
- Sleep disturbance or increased sleeping.
- Poor concentration and deterioration of performance at school.