Diagnosis and Treatment Strategies for Childhood Asthma

Childhood asthma is a chronic respiratory condition that affects about 14% of children and young people worldwide. It is characterized by wheezing, shortness of breath and coughing, which are usually triggered by various stimuli, such as allergens, infections, exercise or cold air. Asthma can have a significant impact on the quality of life of children and their families, as well as increase the risk of hospitalizations and mortality.

Diagnosing asthma in children can be challenging, especially in younger age groups, because of the variability of symptoms, the overlap with other respiratory conditions and the limitations of lung function tests . Therefore, the diagnosis should be based on a comprehensive assessment of the child’s medical history, symptoms, physical examination and response to treatment . The diagnosis should also be reviewed regularly to confirm its accuracy and to adjust the treatment plan accordingly.

The main goals of asthma treatment are to prevent symptoms, reduce the frequency and severity of exacerbations, maintain normal lung function and physical activity, and minimize adverse effects of medications . The treatment involves a combination of pharmacological and non-pharmacological interventions, as well as education and self-management support .

Pharmacological treatment consists of two types of medications: controller medications that are taken daily to reduce inflammation and prevent symptoms, and reliever medications that are used as needed to relieve acute symptoms and treat exacerbations . The choice and dose of medications depend on the age, severity and control level of asthma, as well as the individual preferences and response of the child and the family . The most commonly used controller medications are inhaled corticosteroids (ICS), which are effective and safe for long-term use in children with asthma . Other controller medications that can be added to ICS or used as alternatives include leukotriene receptor antagonists (LTRA), long-acting beta-agonists (LABA), theophylline and anti-IgE therapy . The most commonly used reliever medication is short-acting beta-agonist (SABA), such as albuterol or salbutamol, which can rapidly relax the airway muscles and improve airflow . Other reliever medications that can be used in some cases include anticholinergics, systemic corticosteroids and magnesium sulfate .

Non-pharmacological interventions include avoiding or reducing exposure to asthma triggers, such as allergens, irritants, infections or cold air [^5^. Modifiable risk factors, such as obesity, smoking, stress or poor indoor air quality, should also be addressed to improve asthma outcomes[^1^. Additionally, immunizations against influenza and pneumococcal disease are recommended for children with asthma to prevent complications from these infections[^1^. Exercise is beneficial for children with asthma, as it can improve lung function, cardiovascular fitness and quality of life[^1^. However, exercise-induced bronchoconstriction (EIB) is a common problem that can limit physical activity in some children with asthma[^1^. Therefore, preventive measures, such as using a SABA before exercise or warming up properly, should be taken to avoid or minimize EIB[^1^.

Education and self-management are essential components of asthma care that can empower children and their families to cope with the condition effectively[^1^. Education should cover topics such as the nature and causes of asthma, the signs and symptoms of worsening asthma, the proper use of inhalers and spacers, the role and benefits of different medications, the importance of adherence to treatment, the identification and avoidance of triggers, the management of modifiable risk factors and the actions to take during an asthma attack[^1^. Education should be tailored to the age, developmental stage, cultural background and learning needs of the child and the family[^1^. Self-management involves using a written personalized asthma action plan (PAAP) that provides clear instructions on how to monitor asthma control using symptoms or peak expiratory flow (PEF) measurements, how to adjust medications according to control level or exacerbation severity, and when to seek medical help or emergency care[^1^. PAAPs have been shown to improve asthma outcomes and reduce health care utilization in children with asthma[^1^.

Asthma is a complex and dynamic condition that requires a holistic and individualized approach to diagnosis and management. Working in partnership with children and their families is key to achieving optimal asthma control and preventing complications. Regular follow-up visits and reviews are necessary to monitor asthma status, evaluate treatment effectiveness and address any concerns or difficulties that may arise.

References:

: Martin J, Townshend J, Brodlie M. Diagnosis and management of asthma in children. BMJ Paediatr Open. 2022;6(1):e001277. doi:10.1136/bmjpo-2021-001277
: Childhood asthma – Diagnosis & treatment – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/childhood-asthma/diagnosis-treatment/drc-20351513. Accessed November 9, 2023.
: Treating asthma in children under 5 – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/childhood-asthma/in-depth/asthma-in-children/art-20044376. Accessed November 9, 2023.
: Asthma – Asthma in Children | NHLBI, NIH. https://www.nhlbi.nih.gov/health/asthma/children. Accessed November 9, 2023.
: Asthma: diagnosis, monitoring and chronic asthma management. https://www.nice.org.uk/guidance/ng80. Accessed November 9, 2023.