Paediatrics: Asthma: clinic management (1)

2021-03-04 12:00 AM

The aim of treatment is to allow the child to lead a normal life. In the clinic, you will come across children with seemingly distinct clinical pat-terns of their chronic asthma.

Asthma: clinic management (1)

The aim of treatment is to allow the child to lead a normal life. In the clinic, you will come across children with seemingly distinct clinical pat-terns of their chronic asthma. Patients with frequent or persistent asthma should be seen in a specialist clinic. The nebulized treatment is used in severe acute asthma. It is not recommended in mild to moderate severity of asthma. Instead, use multi dosing (up to 10 puffs) bronchodilator.

Infrequent episodic asthma

Characteristics

  • 75% of asthmatics.
  • <4 episodes per year.
  • Symptom-free between acute episodes.
  • No regular treatment needed.

Management strategy

  • Treat acute episodes with B2-bronchodilators.
  • Use nebulized bronchodilators and short-course prednisolone in more severe episodes (i.e. prednisolone 3 days, given once daily in the morning after breakfast with no need to taper treatment).

Frequent episodic asthma

Characteristics

  • 20% of asthmatics.
  • Episodes every 2–4 weeks.
  • Regular treatment is needed.

Management strategy

  • Use B2-bronchodilator as required.
  • Use regular, low-dose inhaled steroid.

Persistent asthma

Characteristics

  • Less than 5% of asthmatics.
  • >=3 episodes/wk, with a cough at night/morning.
  • Regular treatment is needed.

Management strategy

  • Use prophylactic inhaled steroids.
  • Long-acting B2-bronchodilator may be helpful.
  • Oral steroids may be needed.
  • Oral leukotriene inhibitors may enable a reduction in steroid usage.

Exercise-induced asthma

Management strategy

  • Mild: use β2-bronchodilator before exercise.
  • Severe: low-dose inhaled steroid.

Escalating therapy

Having reviewed the history and categorized your patient in terms of clinical pattern and severity, use a logical, stepwise approach to escalating therapy.