tags:
- paeds/respiAsthma
Definition
Chronic airway inflammation leading to bronchospasm + recurrent episodes of wheezing, breathlessness, chest tightness and coughing + triggered by cold weather, dust, fur or exercise.
*asthma is a reversible airway obstruction
Clinical Features
History
- Current symptoms
- Pattern of symptoms
- Precipitating factors
- Present treatment
- Previous hospital admission
- Typical exacerbations
- Home/ school environment Impact on life style
- History of atopy
- Response to prior treatment
- Prolonged URTI symptoms
- Family history
Physical Examination
- Signs of chronic illness
- Harrison’s sulci
- Hyperinflated chest
- Eczema / dry skin
- Hypertrophied turbinates
- Signs in acute exacerbation
- Tachypnoea
- Wheeze, rhonchi
- Hyperinflated chest
- Accessory muscles
- Cyanosis
- Drowsiness
- Tachycardia
Children less than 5 years old
To diagnose asthma
- Largely based on symptoms pattern + clinical history + physical findings
- Predictive factor: +ve family history & atopy
- It is difficult to diagnose asthma in this age group because wheeze and cough are common in children without asthma
Features suggestive of asthma
-
Cough
- Recurrent/persistent non-productive cough, worsens at night, accompanied by wheeze or breathlessness. Cough in the absence of respiratory infections, usually with laughing, crying or exposure to tobacco smoke.
-
Wheezing
- Recurrent wheezing during sleep or with triggers such as activity, laughing, crying or exposure to tobacco smoke or air pollution
-
Shortness of breath
- Difficult or heavy breathing or shortness of breath occurring with exercise, laughing or playing.
-
Reduced activity
-
Past/family history
- Allergic disease or asthma in first degree relative.
-
Therapeutic trial with moderate dose inhaled steroids
- Clinical improvement in 2-4 weeks of controller treatment and worsening when treatment is stopped.
Management
Treatment of Asthma for Children <5 y/o
Step 1
Controller: nil
Reliever: SABA PRN
For children with: Infrequent viral wheezing and no/few interval symptoms
Step 2
Controller: Daily low dose ICS (preferred), LTRA
Reliever: SABA PRN
For children with: Symptoms consistent with asthma, not well-controlled asthma, ≥3 exacerbations per year
Step 3
Controller: Double low dose ICS (preferred), low dose ICS + LTRA
Reliever: SABA PRN
For children with: Asthma diagnosis, not well-controlled asthma on low dose ICS
Step 4
Controller: Continue controller and refer to specialist (preferred), add LTRA, increase ICS freq.
Reliever: SABA PRN
For children with: Poorly controlled asthma on double ICS
