Asthma%20(pediatric) Management

Periodic Assessment and Monitoring

• Periodic assessment and monitoring of asthma control should be performed to determine whether the goals of therapy are met (ie reduction of current impairment and future risk, and achievement of normal activity levels including exercise)
  • Several tools are used that allow patient and parents to record and describe the symptoms [eg asthma control test (ACT), childhood ACT, asthma quiz for kids, diaries]
• Improvement of symptoms may be observed within days while max benefit may be achieved after 3-4 months
• Regular follow-up is recommended to determine minimum controlling dose and necessary dose adjustments
  • 1-3 months after initiation of therapy, then every 3-12 months thereafter

Monitoring Signs and Symptoms

• Daytime asthma symptoms (wheezing, cough, chest tightness or shortness of breath)
• Nocturnal awakening as a result of asthma symptoms
• Frequency of use of beta₂-agonist (inhaled, rapid-acting) for relief of symptoms
• Inability or difficulty in performing normal activities because of asthma symptoms

Pulmonary Function

• Results in children 5 year of age and younger are unreliable or may not be reproducible
• Spirometry
  • Low forced expiratory volume in 1 second (FEV₁) is associated with increased risk of severe exacerbations
• Peak Flow Monitoring
  • Peak flow meters function best as tools for ongoing monitoring, not diagnosis
  • Refer to the patient’s written asthma action plan for the patient’s personal best peak flow
  • Because measurement of peak expiratory flow (PEF) is dependent on effort and technique, patient instructions, demonstrations and frequent reviews are recommended

Quality of Life

• Any school day missed because of asthma
• Any reduction in usual activities (eg home, school, recreation, exercise)
• Any sleep disturbance due to asthma
• Any change in the caregiver’s activities due to asthma

History of Asthma Exacerbations

• Frequency
• Rate of onset
• Severity
• Cause

Monitoring Adherence to Therapy

• Adherence to drug regimen
• Patient concerns about drug regimen
• Adverse effects experienced with the drug regimen

Monitoring Patient-Provider Communication and Patient Satisfaction

• Patient’s negative attitude toward medication and/or reluctance towards self-management are risk factors for severe exacerbations

• It is believed that asthma development and persistence are driven by gene-environment interactions thus interactions during pregnancy and early in life has a great influence
• Preventing the onset of disease is called primary prevention

Nutrition

Breastfeeding

• It may decrease wheezing episodes in early life but may not prevent developing asthma
• It is still encouraged for all of its positive benefits

Vitamin D

• Some studies show that maternal intake of vitamins D and E lowers the risk wheezing illnesses in children

Allergens

• There are conflicting evidences on the effect of pet allergens on patients with asthma
• Dampness, visible mold and mold odor should be eliminated as studies suggested that exposure to these home allergens increase the risk of developing asthma

Vaccinations

• Annual influenza vaccination may help reduce acute exacerbation in patients with moderate-severe asthma
• Vaccination against COVID-19 is recommended for patients with asthma with observation of a 14-day gap between COVID-19 vaccination and influenza vaccination

Pollutants

• Smoking during pregnancy has a strong effect on young children while post-natal maternal smoking has an effect only to asthma development in older children
• Exposure to tobacco and e-cigarette smoke is associated with an increased risk of asthma symptoms, asthma exacerbation, hospitalization and poor asthma control
• Avoid exposure to environmental tobacco smoke during pregnancy and the first year of life
• There is an increased risk of asthma associated with exposure to outdoor pollutants (eg residence near a main road)
• Remind parents/caretakers of patients with asthma not to smoke

Microbial effects

• Exposure to microbiota may be of benefit in the prevention of asthma
• Children exposed to potential allergens early in life (eg farm stables and animals, unprocessed milk) present with lower risk for asthma development compared to other children
• Infants born via vaginal delivery may be at lesser risk for asthma than those born by caesarean section (C-section)
  
  • The mode of delivery may be associated with the differences between infants’ gut microflora

Medications and Other Factors

• Paracetamol/Acetaminophen, analgesic and broad-spectrum antibiotics use in the 1st-2nd year of life is discouraged

Psychosocial Factors

• There is an increased risk of asthma development if there is maternal distress that persists from birth through to early school age

• Studies show that overweight or obesity is a risk factor for childhood asthma and wheezing