Asthma Children -2016
Diagnosis and assessment-Consider monitored initiation of treatment with very low-to low-dose ICS.Infrequent , short lived wheeze
Asthma diagnosed-Evaluation ○ assess symptoms , measure lung function , check inhaler technique and adherence ○ adjust dose ○ update self – management plan ○ move up and down as appropriate.
Regular preventer Very low ( paediatric dose ICS ) ( or LTRA < 5 yrs )- Initial add-on preventer.Very low ( paediatric dose ICS ) Plus Children > 5 yrs – add inhaled LABA Children < 5 yrs – add LTRA- Additional add-on therapies No reponse to LABA-stop LABA and ↑ dose of ICS to low dose If benefit from LABA but control still inadequate – continue LABA and ↑ ICS to low dose If benefit from LABA but control still inadequate- continue LABA and ICS and consider trial of other therapy – LTRA
High dose therapies Consider trials of : Increasing ICS upto medium dose Addition of a fourth drug- SR theophylline Refer patient for specialist care.Continous or frequent use of oral steroids Use daily steroid tablet in the lowest dose providing adequate control Maintain medium-dose ICS Consider other treatments to minimize use of steroid tablet Refer patient for specialist care. Short acting Beta 2 agonist as required- consider moving up if using three doses a week or more.In children with an intermediate probablity of asthma who cannot perform spirometry consider watchful waiting if the child is asymptomatic offer carefully monitored trial if the child is symptomatic
Reference British guideline on the management of asthma- BTS SIGN September 2016