Acute and chronic management of childhood asthma Dr S Wa Somwe Adapted from GINA and BTS guidelines
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