Bronchial Asthma in Children : Definition, Etiology,Types, Pathophysiology, Symptoms, Diagnosis, Management, & PPT
Definition
- Asthma is a chronic inflammatory disorder of the respiratory airways which is due to hyper responsiveness of the tracheobronchial tree to a variety of stimuli resulting in widespread spasmodic narrowing of airway. which
- Relieved spontaneously or by therapy.
Hallmark feature are
- Intermittent and reversible airway obstruction
- Chronic bronchial inflammation with eosinophils
- Bronchial smooth muscle cell hypertrophy and hyper-reactivity
- Increased mucus secretion
Classification
| Step | Symptoms | Night time symptoms | Peak expiratory flow rate (PEFR) |
| 1. Intermittent | < 1 times a week
↓ Asymptomatic & normal PEFR between attacks |
≤ 2 times a month | ≥ 80% predicted, variability < 20% |
| 2. Mild persistent | > 1 times a week but < 1 time a day | > 2 times a month | ≥ 80% predicted, variability 20-30% |
| 3. Moderate persistent | Daily use β2 agonists, Daily attacks affects activity | > 1 times a week | > 60% & < 80% predicted, variability > 20% |
| 4. Severe persistent | Continuous limited physical activity | Frequent | ≤ 60% predicted, variability > 30% |
Clinical Presentation
Recurrent episodes or paroxysms of
- Wheezing,
- Breathlessness,
- Dyspnoea,
- Chest tightness,
- Cough
Presents particularly at night and/or early in the morning.
Status asthmaticus: When a patient suffer from severe paroxysm that does not respond to therapy and persists for days and even weeks.
Treatment
A. Intermittent type
No daily medication
↓Attack
Inhaled SABA for any acute attack
B. Mild persistent
Daily low dose inhaled corticosteroids
+
Inhaled SABA for any acute attack
3. Moderate persistent
Daily low dose inhaled corticosteroids
+
Daily inhaled LABA
+
Inhaled SABA for any acute attack
4. Severe persistent
Daily low dose inhaled corticosteroids
+
Daily inhaled LABA
+
Daily oral leukotriene antagonist
+
Inhaled SABA for any acute attack
OR
Medium dose inhaled corticosteroids daily
+
Daily inhaled LABA
+
Inhaled SABA for any acute attack
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