Asthma in Children

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | Patient Advice

Definition

Asthma is a chronic inflammatory condition of the airways characterised by reversible airflow obstruction, bronchial hyperresponsiveness, and airway inflammation. In children, symptoms can vary significantly in frequency and severity.

Aetiology

The underlying causes of asthma in children include:

• Genetic Factors: Family history of asthma or atopy (eczema, hay fever).
• Environmental Triggers: Allergens such as dust mites, pollen, or pet dander.
• Infections: Viral respiratory infections in early childhood.
• Smoking Exposure: Maternal smoking during pregnancy or second-hand smoke exposure.

Pathophysiology

The pathophysiology of asthma involves:

• Airway Inflammation: Leads to swelling and increased mucus production.
• Bronchoconstriction: Narrowing of the airways due to smooth muscle contraction.
• Airway Hyperresponsiveness: Exaggerated response to triggers.

Risk Factors

Common risk factors include:

• Family history of asthma or other atopic conditions.
• Low birth weight or prematurity.
• Exposure to second-hand smoke.
• Urban living with exposure to pollution.

Signs and Symptoms

Asthma symptoms can vary in severity and frequency:

• Wheezing: High-pitched whistling sound, especially during expiration.
• Dyspnoea: Shortness of breath, often worsened by physical activity or cold air.
• Cough: Persistent or recurrent, often worse at night or early morning.
• Chest Tightness: A sensation of constriction in the chest.

Investigations

Diagnostic tests and findings include:

• Clinical Assessment: Based on history of symptoms and triggers.
• Spirometry: Not typically used in children under 5; may show reduced FEV₁/FVC ratio in older children.
• Peak Expiratory Flow (PEF): May indicate variable airflow obstruction.
• Allergy Testing: To identify potential allergens (e.g., skin prick testing).

Management

Under 5 Years

Step 1: Very Low Dose Inhaled Corticosteroids (ICS)

• Clenil Modulite® 50 pMDI: 2 puffs twice daily (BD).
• Salbutamol (SABA): 2 puffs as needed for symptom relief.

Step 2: Add Leukotriene Receptor Antagonist (LRTA)

• Montelukast: 4 mg in the evening for children aged 6 months to 5 years.
• Monitor response after 4–8 weeks and discontinue if ineffective.

Step 3: Low Dose ICS

• Clenil Modulite® 100 pMDI: 2 puffs BD.
• Refer to a specialist if symptoms remain uncontrolled.

6–11 Years

Step 1: Very Low Dose ICS

• Clenil Modulite® 50 pMDI: 2 puffs BD.
• Salbutamol (SABA): 2 puffs as needed for symptom relief.

Step 2: Low Dose ICS

• Clenil Modulite® 100 pMDI: 2 puffs BD.

Step 3: Low Dose ICS + LABA

• Seretide Evohaler 50/25 pMDI: 2 puffs BD.

Over 12 Years

Management aligns with adult asthma but adjusted for age and dosage:

Step 1: Low Dose ICS + LABA

• Symbicort Turbohaler® 200/6: 1 puff BD.

Patient Advice

Key advice includes:

• Ensure proper inhaler technique for effective medication delivery.
• Adhere to prescribed treatment and attend follow-ups for asthma reviews.
• Identify and avoid known triggers where possible.
• Parents should monitor symptoms and know when to seek medical attention for exacerbations.
• Maintain regular physical activity to improve lung health, but manage exercise-induced symptoms with SABA.