ASTHMA

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Last Updated : 12/21/2010
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C T Deshmukh
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• Education of patient and active partnership of patient and doctor is the cornerstone of asthma management.
• Starting patient and family education at the time of diagnosis, integrating it into every step of clinical asthma care, and tailoring it specifically to the needs of each patient, with sensitivity to cultural beliefs and practices.
• Patient education covers
1.

Basic asthma facts

- Taught to understand their asthma; to know how to recognize symptom patterns indicating that their asthma is getting out of control. This can prevent emergency room visits and hospitalizations
2.

Roles of medications

– difference between quick relief and long term control
3. Skill needed for inhaler and spacer use and self monitoring with PEFR meter
4. Environmental control measures and avoidance measures.
5. When and how to take rescue steps, written treatment plans.

What is asthma?
Asthma is a chronic disorder that causes spasm of the airway leading to narrowing of the air passage and attacks of cough, wheeze and breathlessness. The spasm may occur due to exposure to allergens, chemical irritants, smoke, cold air and exercise.

What is the incidence of asthma?
Asthma tends to affect about 10% of children globally. Why certain patients are susceptible to asthma is still not known.
Asthma due to allergy may also be associated with eczema, allergic rhinitis and allergic conjunctivitis. Also, allergic predisposition tends to run in families with inheritance between 40-60%. Thus, though allergic predisposition may be inherited, its manifestations may differ between parent and child.

What is the outcome of asthma in childhood?
Wheezing in the 1st 3 years on life is usually benign and is due to small airways in early life. As the airways grow, these children may become less prone to wheezing during viral infections. However, asthma due to allergic inheritance may persist later in life. Also severe asthma may also persist in adult life.

How does asthma present in a child?
In children, rather than wheezing and breathlessness, cough is the predominant symptom. Cough may recurrent and may get aggravated during sleep and exercise.

How is childhood asthma diagnosed?
Asthma in children is mainly a

clinical diagnosis

. Following symptoms may be suggestive of asthma:

Recurrent episodes of wheezing
Recurrent cough – more troublesome at night
Cough or wheeze after exercise
Breathing problems during a particular season
Cough or wheeze after exposure to dust, smoke, perfume, animal fur
Child’s cold frequently affecting the chest and takes more than 10 days to resolve
Symptoms relieved with nebulization.
Your doctor may look for wheeze, signs of respiratory distress, associated allergic conditions such as eczema, rhinitis and hay fever. The child’s lung function may be estimated by an instrument called spirometry or peak expiratory flow meter that will measure the peak expiratory flow rate (PEFR). PEFR increases by >15% in children with asthma after treatment with bronchodilators.

However there are certain conditions that may mimic asthma such as reflux, cardiac diseases, cystic fibrosis, immunodeficiency, sinusitis and even a foreign body aspiration. But these can be ruled out by associated symptoms and clinical examination.

What is treatment for asthma in children?
The main aspect of treatment is to ensure proper control of asthma. The aim of therapy is to achieve the best quality of life and minimize symptoms. Thus the goals of asthma care are:

Freedom from symptoms, acute attacks, frequent school absences and maintaining normal daily activities, sports participation and growth.

What happens if asthma is not properly controlled?
If asthma is not properly controlled, it may lead to impoverished quality of life, repeated attacks which may be life threatening, poor growth and limitation of physical activities.

What are
drugs used to treat asthma
?

The drugs used to treat asthma fall into 2 broad categories:
(1) Relievers - that relieve the acute symptom
(2) Preventers – that prevent the acute attack.
Patients with persistent asthma require treatment with preventers such as inhaled steroids, long acting bronchodilators and other newer drugs such as montelukast which needs to taken daily on long term basis.
Patients with acute attack need to be treated in a hospital and require treatment with inhaled bronchodilators such as salbutamol and oral/IV steroids for the acute episode.

What is inhaled therapy?
Metered Dose Inhaler
(MDI/ Pumps):
A suspension of drug (either solid particles or liquid droplets) in a gaseous medium forms a drug aerosol. This aerosol is available as a metered dose inhaler (MDI) that delivers a fixed amount of medication each time it is activated.

How to use a metered dose inhaler?
1. Remove the mouthpiece cover and shake the inhaler
2. Place the mouthpiece in the mouth between the teeth and seal lips around it, taking care not to bite
3. While breathing in slow and deep, press the canister and continue to inhale deeply
4. Remove the inhaler from the mouth and hold the breath for about 10 seconds
5. May repeat another inhalation after one minute.

In children, inhalation from an MDI directly may be difficult, as it requires hand-mouth co-ordination. Spacer devices are available that aid in such situation. The spacer is attached to the MDI and the children inhale from the spacer without having hand-mouth co-ordination. In small children babies (children below 3 year), who cannot inhale through a mouthpiece, a facemask is attached to the end of the spacer.

How to use a spacer?
1. Assemble the spacer
2. Shake the inhaler. Insert the inhaler into the spacer
3. Place the mouthpiece of the spacer in the child’s mouth
4. Encourage the child to breathe in and out slowly and gently. (This will make a ‘clicking’ sound as the valve opens and closes). Once the breathing is established normally, depress the canister while the child continues to breathe several times
5. Remove the device from the child’s mouth.

Dry Powder Inhalers (DPI/Rotahaler): A capsule of the drug is inserted in a rotahaler device and broken into two halves. The patient inhales the powder through the mouthpiece. Other dry powder devices available are Diskhalers, Spinhalers, Turbohalers etc.

Which is the best inhaler that can be used?
The device best for a patient depends on:
1. Age, level of comprehension and understanding
2. Cost of the therapy
3. Side effects of the drugs used
Thus, individual requirements differ and a device is selected according to a particular patient’s requirements.

How is asthma prevented?
Exposure to allergens, smoke, house dust mite, fungi, pollen, pets, upholstered furniture, soft toys should be reduced. Reducing cockroach infestation is advisable. Coloring agents and artificial preservatives in food items should be avoided.

Can asthma be cured?
No, asthma cannot be cured. Some children may outgrow asthma if it starts too early in life. However, asthma can be well controlled if proper precautions and treatment are undertaken.

References

Contributor Information and Disclosures C T Deshmukh
Department of Pediatrics, KEM Hospital, Mumbai, India


First Created : 12/21/2000
References
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