Asthma is a reversible obstructive airway disease characterized by swelling, secretions and airway spasm.
The diagnosis of asthma made using a breathing test called spirometry. As such, it is often difficult to formally diagnose young children who are not able to perform such a test.
This makes it difficult to distinguish between viral induced wheeze, bronchiolitis and asthma at a very young age.
Symptoms include: wheezing (musical sound on expiration), cough, shortness of breath
Common triggers include: respiratory tract infections, allergens, exercise, cold air, dust, pollen, medications (aspirin, b-blockers), passive smoking.
Risk factors: family history of asthma/atopy, maternal/passive smoking. Atopy - allergic rhinitis, eczema, atopic dermatitis
Diagnosis: spirometry (pre/post bronchodilator), peak expiratory flow
Treatment:
- Treatment is based on severity of symptoms: mild, intermittent, persistent. This is based on frequency of exacerbations, the presence of interval symptoms, the amount of respiratory distress.
- A stepwise approach should be consider based on severity:
- Short acting beta agonist (SABA) as needed
- SABA plus low dose inhaled corticosteroid (fluticasone, budesonide)
- SABA plus medium dose inhaled corticosteroid
- SABA plus medium dose ICS plus montelukast
- SABA plus high dose ICS plus montelukast
- SABA plus high dose ICS plus montelukast plus oral corticosteroid
Note that LABA (long acting beta 2 agonists) are not recommended in young children (<5 years) due to lack of evidence. In older children LABA can be used to substitute montelukasts
Additionally, childnre with severe persistent asthma with evidence of allergic sensitisation and elevated IgE - an immunomodulator (omalizumab) may be considered.
All children with diagnosis or suspected asthma should receive an asthma action plan.