PEDIATRIC ASTHMA TREATMENT

Goal of treatment is asthma are consisted of several terms. The main goals are following : (1)
prevention of chronic and troublesome symptoms, (2) maintaining normal activity levels, (3)
providing optimal pharmacotherapy with minimal adverse effects, and (4) meeting the patients
and/or his familys expectations. While from clinical perspective from expert panel guidelines, the
definition of well-controlled asthma includes (1) asthma symptoms twice a week or less; (2) use
of rescue medication twice a week or less; (3) no nighttime or early morning awakenings; (4) no
limitation of activity at school, home, or place of work; and (5) asthma that is well controlled from
the assessment of patient, family, and caregiver.1 Well-controlled asthma requires sustained
treatment and it is possible to achieve in 80% of patients.

Management of asthma in children composed of four components. The four components are
assesment and monitoring, controlling factors contributing to severity, pharmacologic therapy and
patient education.1 History is paramount in the assessment of the asthmatic child. One needs to
obtain information about night-time and morning symptoms, school absences, and whether the
patient is able to keep up with his peers in play or sports. Older children may report not feeling
well a good part of the time. In general, information about the youngsters performance in school
and whether or not he limits his participation in sports and play, tailored to what degree his asthma
allows him to do, are of value in assessing the patients status.
Tabel assesment itu
In the older child capable of performing spirometry, periodic assessment is recommended.
Spirometry should be done on the initial visit and after treatment. It will also serve to establish
when normal or near-normal pulmonary function has been attained. Performing a spirometry every
year thereafter assures the clinician that a normal or near-normal pulmonary function test (PFT)
has been maintained or restored following modifi cations of any regimen. Every child if old enough
or his parent or caregiver should be able to recognize through adequacy of symptom control. Based
on preconceived perceptions on what is acceptable control, previously agreed upon modifi cations
in medication can be added or modified.1
The second component is controlling factors contributing to severity. For viral upper respiratory
infections, utilizing currently available vaccines like the flu vaccine and reducing exposure to
infections is desirable.

Tobacco smoke is certainly a completely avoidable irritant, and most parents when told that
smoking cessation is really something they are doing not just for themselves but principally for
their love ones invariably are more than willing to make the necessary changes in their lifestyles.

Dust mite antigens are present in every home in the country, and while eliminating this antigen
completely is an impossible task, dust control measures significantly contribute to the well-being
of the dust mite-sensitive patient. Dust mites dwell where food for them is abundant. Human
dander being the source of food for mites, mites understandably are mostly found in pillows,
mattresses, and box springs. Of equal importance is the need to lower the humidity in the home to
below 50 %. Parents need to know that high humidity is conducive to enhanced mite growth.

In inner city dwellings, cockroach antigen and mouse antigens can be an important part of the
environmental milieu. Cockroaches thrive best when garbage and food leftovers are left exposed.
The use of boric acid traps allows one to avoid using poisons as this method adds another hazard
for accidental ingestions. For mold allergens, attentions can be directed to leaky faucets and wet
areas. As in dust mite avoidance, reducing humidity to less than 50 % can minimize mold exposure.
For patients sensitized to pollens, confinement in air-conditioned rooms is undoubtedly the best
barrier to pollen exposure but is not practical. In areas where clothesline drying of laundry is
commonly practiced, the moist laundry allowed to dry on a clothesline collects pollens, bringing
into the home quantities of pollen where it is recirculated for an indefinite period. The hair collects
pollens so a typical pollen allergic patient may bring in a bagful of pollens to bed. So asking
patients to wash their hair at night instead of in the morning can be helpful. In patients with
coexisting allergic conjunctivitis, contact lenses are a drawback. Pollen grains can potentially be
trapped underneath these lenses creating an ever-present reservoir of antigens. On the contrary,
eyeglasses act as a windshield and thus theoretically block the entry of allergen directly to the eyes.
As you can imagine, all these measures cost money to implement and perhaps the greatest obstacle
to all the above is Poverty. And the greatest number of poorly controlled asthma in children is
found in poverty-stricken areas
The third component in managing asthma in children is pharmacologic theraphy. Attention has
been called earlier for the need to assess the severity of the childs asthma before embarking on
treatment. There are two approaches to the pharmacologic management of asthma in children. The
one that is preferred by most practitioners is an aggressive approach where one attempts to control
symptoms as rapidly as possible by using a dose higher than the perceived requirement for any
given level of severity. This is usually accomplished by adding short burst of oral corticosteroid
(usually prednisone or prednisolone) for a 310-day period added to the selected ICS. As soon as
control is achieved, the dose is then titrated to a level that will maintain control. The alternative
approach is to select a dose level appropriate for the perceived severity of the condition gradually
titrating the dose upward until the desired level of control has achieved.1

Reference
1. Guiang S. Pediatric Asthma. In: Massoud mahmoudi, ed. Allergy and Asthma: Practical
Diagnosis and Management. 2nd ed. springer; 2016:209-222. doi:10.1007/978-3-319-
30835-7.