Childhood Asthma (2) – Diagnosis, Treatment and Prevention

In the first part of this series on childhood asthma:

we established the fact that children can indeed have asthma just like adults. We discussed the common symptoms of asthma and the various possible trigger factors. In this concluding part, we will look at how the diagnosis of asthma is made and the treatment options available. We will conclude with tips for prevention of asthma attacks.

If your child has any of the symptoms we discussed in childhood asthma – symptoms and trigger factors , you need to take the child to the hospital.

The doctor will ask questions about the above symptoms, and examine the child especially the chest using a stethoscope to listen for wheezes (Ronchi) in the chest.

For older children, the doctor may require them to blow into a small equipment called Peak Expiratory Flow Meter.

This instrument measures the Peak Expiratory Flow Rate (PEFR) which can then be compared to what is normal for the child’s age. Medications called bronchodilators (for example salbutamol) could also be given to see if the PEFR increases after administration which also helps strengthen the diagnosis of asthma as children with asthma will have improved PEFR after the administration of bronchodilators usually by nebulization.

Some children present first with an acute episode of asthma and these are easily diagnosed during history taking and physical examination. However, some children have lingering symptoms which are not sudden onset but disturbing, example, frequent night coughs. There are other tests that can be done for asthma include allergy test

Diagnosed to have asthma, what’s next?

There is no need to panic.  Even though asthma is a chronic illness, it is treatable and symptoms can be controlled. We have children and adults who have asthma that are actively involved in sports and are doing well.

There is the need to see a Paediatrician regularly to follow up and assess the severity of symptoms. This determines the treatment plan for the child.

There are two categories of medication for the treatment of asthma.

The controller medications which help prevent  asthma attacks and

The reliever medications  which are used during the acute attacks for instant relief.

The effectiveness of treatment commenced is based on the level of severity of the asthma and it needs to be checked at regular follow ups by the doctors. The medication could be adjusted in a step ladder fashion. It could be stepped up if symptoms are not well controlled despite adequate use or stepped down if doing quite well (well-controlled).

A major challenge in the management of childhood asthma is the mode of drug administration. Medications come as inhalers and there are appropriate techniques for the use of different types of inhalers. Most children 6 years and below are not able to obey instructions to master these techniques, hence it require a means of drug administration. This informs the use of spacer devices and nebulizers. Nebulizers are also useful for most asthmatics during acute episodes when the inhaler is not effective.

There are also oral medications used in the treatment of both acute episodes of asthma and chronic asthma. These are prescribed as necessary.

HOW TO PREVENT EPISODES

• Careful planning and staying away from asthma triggers are the best ways to prevent asthma
• Limit exposure to asthma triggers. Be proactive in helping your child avoid the allergens and irritants that trigger asthma symptoms.
• Don’t allow smoking around your child. Exposure to tobacco smoke during infancy is a strong risk factor for childhood asthma, as well as a common trigger of asthma attacks.
• Encourage your child to be active. In as much as your child’s asthma is well-controlled, regular physical activity can condition the lungs to work more efficiently.
• See the doctor when necessary. Check in on a regular basis. Don’t ignore signs that your child’s asthma may not be under control, such as needing to use a quick-relief inhaler too often.
• Asthma changes over time. Consulting your child’s doctor can help you make any needed treatment adjustments to keep symptoms under control.
• Help your child maintain a healthy weight. Being overweight can worsen asthma symptoms, and it puts your child at risk of other health problems.
• Keep heartburn under control. Acid reflux or severe heartburn (Gastro Esophageal Reflux Disease, or GERD) may worsen your child’s asthma symptoms.
• Your child must have an asthma action plan made by the attending doctor. This helps to know what do in case of acute episodes. It shows the daily medications which are for prevention and the rescue medications for attacks.

In conclusion, asthma once diagnosed can be controlled with appropriate treatment. Failure to treat leads to progressive damage to the airways and increasing severity of chronic asthma

Childhood asthma is managed by the child, the parents, the doctor and everyone who is in custody of the child at one time or the other, hence the school should be aware of your child’s condition. Also asides the peak respiratory flow rate, lung function tests can be performed to monitor severity of airway obstruction using a spirometer.