Childhood Asthma

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Childhood Asthma

• Natasha Zurick
• Consultant Paediatrician
• RUH

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Epidemiology

• 50 children have at least one episode wheeze by
  age 3, but 60 of these will stop by age 6
• Approx 20 deaths pa in children in UK
• Deaths from asthma have dropped 6 pa in UK in
  ages 5-64 since 1983
• Admission rates are also steadily falling in UK
• BUT

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UK still has one of the highest rates of wheeze
and asthma in the world
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(No Transcript)
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Admission rates 1979-99
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Diagnosis in children

• Wheeze YOU can hear
• GOOD description of wheeze
• History without concerning features eg neonatal
  onset, wet cough, focal signs, poor growth.
• Response to standard treatment
• Cough without wheeze is not usually asthma

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Asthma Phenotypes

• Martinez NEJM 1995

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Stepwise management ofasthma in children lt12
years
Thorax 2003 58 (Suppl I) i1-i92
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Stepwise management ofasthma in children aged
5-12 years
Thorax 2003 58 (Suppl I) i1-i92
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Stepwise management ofasthma in children aged
5-12 years
Thorax 2003 58 (Suppl I) i1-i92
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Stepwise management ofasthma in children aged
5-12 years
Thorax 2003 58 (Suppl I) i1-i92
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Stepwise management ofasthma in children aged
5-12 years
Thorax 2003 58 (Suppl I) i1-i92
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Stepwise management ofasthma in children under 5
years
Thorax 2003 58 (Suppl I) i1-i92
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Stepwise management ofasthma in children under 5
years
Thorax 2003 58 (Suppl I) i1-i92
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Treatment of Acute Asthma

• Advise salbutamol via spacer. Up to 10 puffs 4
  hourly
• If needing more need to seek medical advice
• Spacers as good as nebs for mild-mod asthma
• If severe try to give nebs with O2 (without can
  make worse due to increasing V/Q mis-match)
• If not improved can use mix of salbutamol and
  ipratropium (atrovent) for next neb.
• Prednisolone 20mg (2-5yrs)/40mggt5yrs

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Adrenal Suppression

• Some risk even at standard high doses ICS
• If on high doses issue steroid card and advise
  never to stop suddenly. Attempt to reduce dose
  slowly.
• Monitor growth in children on ICS.
• Flixotide appears to be particularly high risk
• Avoid high dose steroids whenever possible refer
  to paediatrician for further management.

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Adrenal Crisis and ICSArch Dis Child 2002
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LABA controversy

• Some studies suggest increased death rate in
  patients using LABAs
• ? Related to reducing or stopping ICS
• ? Become less responsive to B2 agonists
• Advice
• Dont use LABA without ICS
• Dont use excessive doses LABA
• ? ? Formoterol less of a problem

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Future Treatments?

• Anti-IgE ( Omalizumab, Xolair)
• Immunotherapy
• New inhaled steroids
• Genetic profile to tailor drugs
• Anti IL-5 and other anti-cytokines
• ?Prevention - parental smoking, anti-oxidants.