Pediatric Asthma Guidelines

In October 2009, the National Institutes of Health released its latest version of the National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3: Guidelines on Asthma. It includes updated information on the appropriate care for children with asthma.

Diagnosing Your Child's Asthma

• Your child has asthma if he has recurrent wheezing, cough, shortness of breath or chest tightness; and if airflow obstruction is episodic and partially reversible when using a bronchodilator. Additonally, asthma should be considered if there is a family history of asthma or allergies; if peak flow monitoring over one or two weeks shows a variation of more than 20 percent; and if trials of controller medicines (inhaled corticosteroids) over one to three months improve your child's breathing.

  Your child should do a test on a spirometer, before and after using a bronchodilator, to confirm the presence of asthma.

Classifying the Severity of Asthma

• Your child's asthma is intermittent if symptoms occur no more than twice a week; if nighttime symptoms occur no more than twice a month; and if peak flow is 80 percent or better.

  It is persistent if symptoms occur more than twice a week and if nighttime asthma occurs more than twice a month; and if peak flow rates are less than 80 percent.

Your Child's Action Plan and Peak Flow Monitoring

• Keep a symptom diary, noting the frequency of asthma symptoms in conjunction with your child's daily activities. If your child is 6 or older, use peak flow monitoring to detect when asthma is getting worse.

Managing Asthma in a Stepwise Fashion

• Inhaled corticosteroids should be used as a controller medication. If he cannot used an inhaled corticosteroid, use a leukotriene receptor antagonist or nedocromil sodium. For children older than 4 with uncontrolled asthma, a long-acting beta antagonist should be considered.

Self-Management of Asthma and Education

• Your doctor should encourage patient education and provide a written action plan for your child's asthma care.

Treating Exercise-Induced Asthma

• If your child has exercise-induced asthma, a short-acting beta-antagonist (bronchodilator) should be used 5 to 15 minutes before he exercises. A leukotriene receptor antagonist is also an option. If your child does not respond, you should be referred to an asthma specialist.

Preventive Treatment of Acute (Short-Term) Asthma Episodes

• If your child is 5 or younger, and does not have persistent asthma, your doctor may prescribe a leukotriene receptor antagonist to prevent asthma exacerbations. He may be referred to an asthma specialist as well.

Discharge after Treatment of an Acute Asthma Episode

• For infants 2 or younger, albuterol (a bronchodilator) is an option for acute asthma episodes. Children and adolescents should be given albuterol through a metered-dose inhaler with spacer (with or without mask) or with a hand-held nebulizer.

  For severe asthma where peak flow is less than 50 percent, your child should be given a nebulizer treatment of ipratropium bromide and a short-acting beta antagonist every 20 minutes (three treatments). For severe asthma where oxygen saturation is questioned, your child may be given supplemental oxygen, and oral or systemic steroids to open the airways.

  When you go home your child may be given oral steroidsl. If for some reason your child does not improve, hospitalization may be recommended and monitored for at least 24 hours.

  Inhaled corticosteroids should be prescribed if your child has persistent asthma; or if your child has already been using an inhaled steroid, the dose may be increased, or an oral corticosteroid prescribed.

Follow-up Monitoring

• Follow up with your doctor over the phone or in person within one week of the asthma episode; again at four weeks, and then every two to four weeks until asthma is controlled. If your child has persistent asthma, visit your child's doctor every four to six months.