Asthma is the most common chronic disease among children worldwide. More than 339 million people are living with asthma. Over 80% of asthma-related deaths occur in low-and lower-middle income countries. Treatment and effective management of asthma saves lives.

Asthma is ongoing (chronic) inflammation of airways in the lungs. This inflammation leads to breathlessness, coughing and wheezing. The severity and frequency of the symptoms vary from person to person, and for some, become worse during physical activity and at night. Symptoms sometimes get significantly worse. This is commonly known as an asthma attack.

Common triggers include allergies, colds and exercise. Asthma is managed by controlling inflammation with drugs, avoiding triggers when possible and using medications to treat asthma attacks.

Asthma is incurable, but manageable. Asthma treatments focus on reducing or eliminating the symptoms of the condition and preventing ongoing airway inflammation. Both clinical and at-home treatments are effective in helping manage the symptoms of childhood asthma.

 

 

Identify and avoid triggers

Education for patients and caregivers should focus on the identification and avoidance of triggers, understanding the uses of prescribed medications and the importance of compliance and monitoring, as well as the proper use of inhalation devices.

 

 

Triggers and Environmental Control

Asthma triggers include allergens from dust mites or mold spores, animal dander, cockroaches, pollen, indoor and outdoor pollutants, irritants (e.g., tobacco smoke, perfumes, cleaning agents), medication (e.g., aspirin or other nonsteroidal anti-inflammatory drugs, beta blockers), physical triggers (e.g., exercise, hyper-ventilation, cold air) and physiologic factors (e.g., stress), respiratory infection [viral, bacterial] and rhinitis).

Environmental control measures include removing carpets from the patient's bedroom and living areas, weekly washing of bedding and clothing in water hotter than 55° C (130°F), the use of specially designed mattress and pillow covers, removing stuffed animals and similar objects that are likely to harbor allergens, keeping pets outdoor.

 

 

 

Pharmacotherapy

Even with lifestyle changes, some children will require medication to manage their asthma symptoms. These asthma medication may include:

• Bronchodilators, which are medications that help to relax the airways and increase airflow.

• Anti-inflammatories, which help to reduce the inflammation and swelling of the airways.

• Bronchodilators are generally used as rescue therapies for quick relief of asthma symptoms.

 

 

 

Long-Term Management of Chronic Asthma

In the management of chronic asthma, there are four main components to therapy.

1. Patient education.

• Improving patient skills in use of spacer devices for Metered-Dose  Inhalers(MDIs).

• Self assessment and environmental control measures.

• Information about medications and their side effects

• When and how to respond to changes in symptoms

2. Avoidance or control of asthma triggers

3. Assessment and monitoring of asthma severity with objective measurements of lung function

4. Comprehensive plans of pharmacologic therapy

 

Beta-2 agonists: are useful for the treatment of both acute and chronic asthma, relaxing the airways relieving the symptoms breathlessness. But they don’t give long-term control because they don’t affect airway inflammation.

• Short-acting inhaled beta-2 agonists (e.g. salbutamol) are beneficial for acute exacerbations of asthma, for the pre-treatment of exercise-induced asthma, and for rescue therapy (quick-relief) in acute episodes of asthma attacks.

• Long-Acting inhaled beta-2 agonists have a duration of action more than 12 hours and are useful for treating chronic asthma that is unresponsive to inhaled anti-inflammatory agents and for treating night-time cough.

• Sustained-release theophylline is a bronchodilator with mild anti-inflammatory effects.

 

 

Inhaled corticosteroids (ICS) are safe and extremely effective therapy for chronic asthma. ICS reduce airway hyper-reactivity and reduce the need for rescue bronchodilator therapy. It is recommended that daily ICS is the treatment of choice for all patients with persistent asthma.

 

Cromolyn and nedocromil  inhibit early and late-phase allergen-induced bronchospasm and acute bronchoospasm after exercise or cold air. Both these  agents are useful as prophylactic agents in children with mild to moderate asthma.

 

Leukotriene antagonist (Zafirlukast and Montelukast) are   effective in improving asthma symptoms, such as allergen, ASA, and exercise challenge, in clinical models of asthma. In chronic asthma, LTRA administration reduces asthma symptoms and rescue beta 2-agonist use, changes that are paralleled by improvements in lung function.

 

Anti-cholinergic agents, such as ipratropium are potent bronchodilators that may also block reflex bronchoconstriction caused by inhaled irritants. They are less effective as bronchodilators than beta-2 agonists for the treatment of asthma.

 

 

Comprehensive plan for asthma

Having an asthma attack can be scary, but there are ways that you and your child can prepare.

The first step you should take after your child has been diagnosed with asthma is to create an action plan. This plan should include information about:

• which medications your child takes

• how often your child takes their medication

• how to notice when your child’s asthma symptoms are getting worse

• when it’s time to head to the hospital

 

 

 

Home Remedies

• Humidifier. If the air in your home is too dry, it may trigger asthma symptoms. Use a humidifier in or near your child’s room to keep the relative humidity. Be sure to clean a humidifier often.

• Breathing exercises. Practicing breathing exercises with your child can help prevent hyperventilation when symptoms flare up.

• Essential oils. Some research has suggested that essential oils may help to reduce airway inflammation. However, more research is needed to determine if essential oils can help reduce asthma symptoms.

 

 

Prevention

• The primary prevention for asthma is to reduce the risk of developing allergies and asthma initially.

• Breastfeeding (longer than 4 months) reduces wheezing episodes.

• Once a child is known to be at risk for repeated asthamatic attacks, prevention is aimed at reducing triggers.

• All standard childhood immunizations are recommended for children with asthma.

 

 

References

1. Eleesha Lockett, M. (2020, April 21). Everything You Want to Know About Asthma in Children. Retrieved from HealthLine: https://www.healthline.com/health/asthma/asthma-in-children
2. JAMES P. KEMP, M. (n.d.). Management of Asthma in Children. Retrieved from American Family Physicians: https://www.aafp.org/afp/2001/0401/p1341.html
3. Sharma, G. D. (2019, January 19). Pediatric Asthma Treatment & Management. Retrieved from Medscape: https://emedicine.medscape.com/article/1000997-treatment#d8
4. Staff, M. C. (n.d.). Treating asthma in children under 5. Retrieved from MAYOCLINIC: https://www.mayoclinic.org/diseases-conditions/childhood-asthma/in-depth/asthma-in-children/art-20044376

 

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