Diagnosis and management

of asthma in children under

the age of five years
Learning objective
• Identifying asthma in children
• Prenatal risk factors of asthma
• Algorithm in identifying asthma in under five years of
age child at PHC and General Hospital
• Steps Asthma Management
• Assessing asthma control in preschool children
• Preparing locally made spacer out of plastic bottles
bottle

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What is asthma in preschool children ?
• Wheezing or coughing that occurs with exercise,
laughing or crying, and symptoms in the absence of
apparent respiratory infection
• History of other allergic disease (eczema or allergic
rhinitis), allergen sensitization or asthma in first-degree
relatives
• Clinical improvement during 2–3 months of controller
treatment, and worsening after cessation
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Prenatal Risk factors for Asthma
• Family history of atopic disease

• Maternal smoking and asthma

• Environmental pollution (especially tobacco smoke and indoor

biomass exposure),

• Nutrition

• Maternal stress

• Use of antibiotics
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• Birth by caesarean section
Sources: ISAAC Publications
Impact of asthma
• Uncontrolled asthma is associated with
• missed school days
• repeated hospitalization
• risk of airway remodeling
• general poor quality of life in the affected children

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Steps Asthma Management

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Pharmacologic management

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Low, medium and high ICS doses: children 6-11
years

This is NOT a table of equivalence. These are suggested total daily doses for the
‘low’, ‘medium’ and ‘high’ dose treatment options with different ICS.
DPI: dry powder inhaler; HFA: hydrofluoroalkane propellant; pMDI: pressurized metered dose inhaler (non-CFC); * see product information 11
GINA 2020, Box 3-6B
Low, medium and high ICS doses: children
5 years and younger

This is NOT a table of equivalence. These are suggested total daily doses for the
‘low’ dose treatment options with different ICS.
BDP: beclometasone dipropionate; DPI: dry powder inhaler; HFA: hydrofluoroalkane propellant; pMDI: pressurized metered dose
inhaler (non-CFC) 12
GINA 2020, Box 3-6B
Assessing asthma control in preschool children

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…Cont

Remove potential risk

Watch patients inhaler
factors : Assess and
technique, check adherence .
manage risk factors

Refer to specialist for

confirmation of asthma

If asthma is confirmed
escalate the steps of
treatment

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Inhalation technique for preschool children
• Use spacers with face mask, in all
children less than five years of age

• Locally prepared plastic bottle based

spacers can be used.

• Clean the spacers with detergents without

rinsing it at least every 2 weeks.
• Tight seal should be created between
mask and face during inhalation and
cleaning face
• Mouth rinse after steroid administration
should be practiced regularly
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Constructing locally made spacers
1. Wash the bottle with soap and water and air dry for a
minimum of 12 hours to reduce electrostatic charge
on the interior plastic.
2. Make a wire mould similar in size and shape to the
mouthpiece of the MDI.
3. Heat the mould and hold in position on the outside
of the base of the plastic bottle until the plastic
begins to melt (~10 seconds). Rotate the mould
180% and reapply to the bottle until the mould melts
through to make a hole.
Prime initially with 10 puffs of
4. While the bottle is still warm, insert the MDI into the medicine to reduce
the hole to ensure a tight fit between the MDI and electrostatic charge on the walls
bottle spacer. 16
Summary
• Asthma in under five children is recognized using
symptoms rather than lung function tests.
• Genetics, environmental , perinatal risk factors are
identified .
• Inhaled corticosteroids are the backbone of asthma
management in under five years of age
• Locally made spacer is effective in delivering inhaled
drugs for asthma symptom control .

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• We would like to thank
• Dr. Rahel Argaw, Dr Hanan Yusuf, Dr Tewodros
Haile and Dr Amsalu Bekele for preparing this
powerpoint