Child Health  |  Asthma Pathway - Types of Asthma




Child Health

Asthma Pathway - Types of Asthma

The major determinant of treatment of asthma symptoms is the pattern of asthma symptoms.
Intermittent asthma does not usually require or respond to inhaled steroids, whereas persistent asthma does.

Intermittent Asthma

Assessment:-

  • Recurrent episodes of wheeze, triggered by virus respiratory infections.
  • No symptoms in between these episodes.
  • Children may be non-atopic or atopic.


The main index of severity in intermittent asthma, is the severity of attacks, in particular the worst ever attack.

The frequency of episodes is not usually a useful measure of severity, as this is primarily due to the frequency of virus respiratory infections, which can be due to factors other than the asthma.

Persistent Asthma

Assessment:-

These children get asthma not only with virus respiratory infections, but also in the intervals between virus-triggered episodes.  The interval symptoms are triggered by exercise, night time, cold or dry air exposure, and allergen exposure.

Children are usually atopic.

Degrees of Severity

The severity of persistent asthma has been classified as:

  • Frequent episodic: exercise and sleep symptoms most weeks
  • Chronic persistent: exercise and sleep symptoms on most days

Degree of Control

A large number of patients underestimate their asthma control.  Close questioning can often revel this.

Assessment of Asthma Control

History - ask about:

  • Waking at night with cough or wheeze
  • Ability to exercise
  • Attendance at school/preschool
  • Amount of β2 agonist used

Examination - look for:

  • Weight and height percentiles
  • Signs of airway obstruction in 'interval phase"
  • Chest deformity


Consider:

  • Symptom diary
  • Lung function testing >6yr


Lung function measurements cannot be readily used to guide asthma management in children under 5 years of age

Peak Flow

Reliable monitoring with peak flow meters (even in clinical drug trials) is poor.  There is little evidence of their value as a long-term monitoring tool, but this does not negate the use of home monitoring and charting at critical times.  These include, for example:

  • At diagnosis and initial assessment
  • When assessing response to changes in treatment
  • When monitoring response during exacerbations as part of an asthma action plan
  • With children who are poor perceivers of airway obstruction


Another way this can me assessed is use a standardised short questionnaire such as the Asthma Control Test.

See printable patient questionaire 4 - 11 yrs and questionaire 10 - 18 yrs

Spirometry

Although asthma is a clinical diagnosis spirometry can be a valuable aid in diagnosis in children old enough to manage this test (6 and older). Asthma centre offers this service for free.

Asthma & Respiratory Management BOP Inc
BOP Asthma Clinics



Last updated : Thursday, May 18, 2017
Next review date : Friday, May 18,2018


Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.