Management of Bronchial Asthma in Children

1. Management of Bronchial
Asthma in Children

2. 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.

3. 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 animal
b. exercise
c. pollens
d. respiratory viral infections
e. exposure to tobacco smoking
f. strong emotional expression

4. 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

5. Diagnostic Procedure:
1. CBC
2. IgE
3. Allergy Skin testing
4. Pulmonary Function Testing
5. X-ray Chest

6. 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 for
reliever/rescue treatment
< 2 days/week > 2 days/week > 2 days/week

7. Classification by Level of 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%

8. 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.

9. 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

10. Management:

11. 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

12. Management:
A. Reliever Medications
- Rapid acting b2 agonists(ventolin)
B. Controller medications
- Inhaled glucocorticoids
- Leucotriene modifiers

13. 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

14. 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

15. 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

16. THANK YOU.