Acute and chronic management of childhood asthma

Dr S Wa Somwe

Adapted from GINA and BTS guidelines

Primary therapies for exacerbations:

• Repetitive administration of rapid-acting inhaled β2-agonist

• Early introduction of systemic glucocorticosteroids

• Oxygen supplementation

Closely monitor response to treatment with serialmeasures of lung function

Primary therapies for exacerbations:

• Repetitive administration of rapid-acting inhaled β2-agonist

• Early introduction of systemic glucocorticosteroids

• Oxygen supplementation

Closely monitor response to treatment with serialmeasures of lung function

Asthma Management and Prevention Program

Component 4: Manage Asthma Exacerbations

Asthma Management and Prevention Program

Component 4: Manage Asthma Exacerbations

Component 4: Asthma Management and Prevention Program

Reliever MedicationsComponent 4: Asthma Management and Prevention Program

Reliever Medications

Rapid-acting inhaled β2-agonists

Systemic glucocorticosteroids

Anticholinergics

Theophylline

Short-acting oral β2-agonists

Rapid-acting inhaled β2-agonists

Systemic glucocorticosteroids

Anticholinergics

Theophylline

Short-acting oral β2-agonists

Component 4: Asthma Management and Prevention Program

Controller MedicationsComponent 4: Asthma Management and Prevention Program

Controller Medications

Inhaled glucocorticosteroids Leukotriene modifiers Long-acting inhaled β2-agonists Systemic glucocorticosteroids Theophylline Cromones Long-acting oral β2-agonists Anti-IgE Systemic glucocorticosteroids

Inhaled glucocorticosteroids Leukotriene modifiers Long-acting inhaled β2-agonists Systemic glucocorticosteroids Theophylline Cromones Long-acting oral β2-agonists Anti-IgE Systemic glucocorticosteroids

Children Less than 5 yrs

Children Less than 5 yrs

Children Less than 5 yrs

Children Less than 5 yrs

Children Less than 5 yrs

Children age 5-12 yrs

Children age 5-12 yrs

Children age 5-12 yrs

Children age 5-12 yrs

Children age 5-12 yrs

Children age 5-12 yrs

Asthma in Apollo private Hospital

• Trained specialist doctors

• investigations to exclude/ confirm other conditions

• PFT to assess severity and reversibility

• 90% patients treated with inhaled corticosteroids

• prompt access to Emergency services and ICCU

Personal presentation, Raj Singh, Syria May 2003

Levels of Asthma Control

Characteristic ControlledPartly controlled(Any present in any

week)Uncontrolled

Daytime symptomsNone (2 or less / week)

More than twice / week

3 or more features of partly controlled asthma present in any week

Limitations of activities

None Any

Nocturnal symptoms / awakening

None Any

Need for rescue / “reliever” treatment

None (2 or less / week)

More than twice / week

Lung function (PEF or FEV1)

Normal< 80% predicted or

personal best (if known) on any day

Exacerbation None One or more / year 1 in any week

controlled

partly controlled

uncontrolled

exacerbation

LEVEL OF CONTROLLEVEL OF CONTROL

maintain and find lowest controlling step

consider stepping up to gain control

step up until controlled

treat as exacerbation

TREATMENT OF ACTIONTREATMENT OF ACTION

TREATMENT STEPSREDUCE INCREASE

STEP

1STEP

2STEP

3STEP

4STEP

5

RE

DU

CE

INC

RE

AS

E

Without actions asthma drugsare available only for rich patients and for animals in rich countries!

New Zealand. Sunday Star. TimesJanuary 4,2004Photo : Kevin Stent

“Those who care for the patients can be taught to manage cases well with what is available.” E Parry The Tropical Health & Education Trust London

Thorax1997;52:589