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ASTHMA IN

CHILDREN

RINTO NUGROHO P.D


Faculty of Medicine Yarsi
Pediatric Department
Rumah Sakit Bhayangkara tk.I R.S. Sukanto-Jakarta
definition
According Scadding and Godfrey, asthma is
a disease characterized by a wide variation
in the short time delays in the flow of air in
the lung airways manifesting as recurrent
bouts of coughing or wheezing (wheezing)
and shortness of breath usually occurs at
night.
Anatomi sistem
pernafasan
Epidemiology

Research ISAAC (International Study of


Asthma and Allergies in Childhood) first
phase conducted in 56 countries obtain
prevalence figures are highly variable
ranging from 2.1% to 32.2% in the group
of 13-14 years and 4.1% up to 32, 1% in
the group 6-7 years.
Variability in asthma prevalance

By gender
Males 0 17 years are more likely than
girls to have asthma or experience an
asthma attack
By race/ethnicity
etiology

Genetic Prediposisi
Atopy
Hiperesponsif airway
classification
Patofisiologi
Clinical manifestations
Intermittent dry cough
Expiratory wheezing
Shortness of breath
Chest pain
Fatigue
Difficulty keeping up with peers in
physical activities
Lab findings
Spirometry:

Feasible in children >6 years of age


Monitoring Asthma and efficacy of
treatment
Measures FVC, FEV 1 and FEV1/FVC Ratio
Normal values for children available on
the basis of height, gender and ethnicity.
Airflow Limitation:
Low FEV1
FEV1/ FVC ratio < 0.80
Supporting investigation
1. Spirometry
2. Peak flow meter/PFM
3. X-RAY Chest/thorax
4. Examination ig-e
5. UHB
therapy
Regular assessment and
Monitoring
Asthma severity:
Directs initial level of therapy
Determined at the time of diagnosis
Categories: Intermittent, Persistent
Determined by the most severe level of
symptoms
Asthma control: Important for adjusting therapy
Regular Clinic visits every 2-6 weeks until good
control established
Two or more Asthma check ups per year for
maintaining Asthma control
Managing Asthma:
Asthma Management Goals
Achieve and maintain control of
symptoms
Maintain normal activity levels, including
exercise
Maintain pulmonary function as close to
normal levels as possible
Prevent asthma exacerbations
Avoid adverse effects from asthma
medications
Prevent asthma mortality
Managing Asthma: Asthma
Action Plan
Develop with a physician
Tailor to meet individual needs
Educate patients and families about all
aspects of plan
Recognizing symptoms
Medication benefits and side effects
Proper use of inhalers and Peak
Expiratory Flow (PEF) meters
Managing Asthma:
Indications of a Severe Attack
Breathless at rest
Hunched forward
Speaks in words rather than complete
sentences
Agitated
Peak flow rate less than 60% of normal
Managing Asthma:
Things People with Asthma Can Do
Have an individual management plan
containing
Your medications (controller and quick-relief)
Your asthma triggers
What to do when you are having an asthma
attack
Educate yourself and others about
Asthma Action Plans
Environmental interventions
Seek help from asthma resources
Join an asthma support group
Control of Factors Contributing
to Severity
Eliminate/ reduce environmental
exposures
Tobacco smoke elimination/ reduction
Allergen exposure elimination/ reduction
Treat co morbid conditions: Rhinitis,
Sinusitis, GER
Inhaled Corticosteroids
Treatment of choice for persistent Asthma
Improve lung function
Reduce use of rescue medicines
Reduce ED visits, hospitalizations
May lower the risk of death due to
Asthma
Systemic Corticosteroids
Used mainly in treatment of
exacerbations
Rarely in patients with severe disease
Common: Prednisolone, Prednisone,
Methyprednisolone
When used in long term, cause adverse
effects
Long Acting -Agonists
Salmeterol, Formoterol
Not used as monotherapy
LABA use should be stopped once optimal
Asthma control is achieved
Leukotriene Modifying Agents
Leukotriene synthesis inhibitor: Zileuton
(Not approved for children < 12 years)
Leukotriene Receptor Antagonists:
Montelukast, Zafirlukast
Non-steroidal Anti-
inflammatory Agents
Cromolyn, Nedocromil
Inhibit exercise induced bronchospasm
Can be used in combination of SABA for
exercise induced bronchospasm
Theophyllin
Can reduce Asthma symptoms and need
for SABA use
Narrow therapeutic window
Not used as first line anymore
May be used in corticostroid dependent
children
Can cause cardiac arrhythmias, seizures
and death
Omalizumab
Anti IgE monoclonal antibody
Blocks IgE mediated allergic response
Approved for children > 12 years with
moderate to severe Asthma
Given sub cutaneously every 2-4 weeks
Rescue Drugs
Short Acting Beta Agonists: Albuterol,
Levalbuterol, Terbutaline, Pirbuterol
Drugs of choice for acute Asthma symptoms
Overuse may be associated with increased
risk of death
Use of at least 1 MDI/ month or at least 3
MDI/ year indicates inadequate Asthma
control
Anticholinergic Agents: Ipratropium bromide
Used in combination with Albuterol
Acute Exacerbations
Dyspnea at rest
Peak flows < 40% of personal best
Accessory muscle use
Failure to respond to initial treatment
Management of Acute
Exacerbation
Brief assessment
Administration of SABA: Repeated doses or
continuously, every 20 mins. for 1 hour
Inhaled anticholinergic in addition of SABA
Oxygen: Hypoxemia/ moderate to severe
exacerbation
Systemic Corticosteroids: Instituted early
for moderate to severe exacerbation and
failure to respond to early treatment
Intramuscular beta agonist in severe cases.
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