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Up | Anatomy lungs | Why asthma occurs | Asthma symptoms | Triggers of asthma | Asthma attack | Asthma diagnosis | Goals asthma therapy | Signs worsening asthma | Management asthma | Asthma children

The revised British guidelines on asthma management.

Management of asthma in children under 5 years of age

    

 

 

Guidelines

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Use inhaled drugs wherever possible.

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Bronchodilators syrups are much less effective than inhaled Bronchodilators and have more systemic side effects.

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Avoidance of provoking factors where possible.

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Working towards self management plan.

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Selection of best inhaler device.

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Help your child fight asthma

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Always encourage your child to take part in normal, day to day activities.

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To boost your child's self confidence, encourage him to do things, he enjoys the most.

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Encourage your child to be as independent as possible.

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As your child grows older, teach him about asthma.

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Teach your child to be totally responsible for taking medicines regularly.

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Your child should know, whom to call in case of emergency.

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Make sure to inform school authorities about your child's asthma.

 

Asthma in children

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A condition of attacks of breathing distress, wheezing, prolonged breathing out, and a noisy cough. 

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It usually begins between 3 and 8 years of age. 

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Asthmatic attacks are caused by a narrowing of the airways. This results from muscle spasm in the lungs, swelling of the bronchial tubes, or excess mucus. 

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Asthma in children is usually caused by an allergy to a foreign substance (allergen), as pollen, mold, house dust, certain foods, animal hair and skin, feathers, insects, smoke, and various chemicals or drugs. 

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In infants, especially those born into a family with a history of allergic reactions, food allergy is a common cause. 

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In some instances, the attacks are caused by other events, as infection or swelling, obstruction by a foreign body, physical stress resulting from weakness, exposure to cold air, or psychological stress. Such cases are classified as non allergic, or intrinsic, asthma.

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There is a strong hereditary factor associated with the disease. As many as 75% of children with asthma have a family history of the disorder. 

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The child usually has other allergic symptoms, as hay fever, eczema, or skin eruptions (urticaria). 

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The disease occurs twice as often in boys as in girls before puberty. Both boys and girls are affected equally during adolescence.

 

Diagnosis

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The condition is often confused with breathing tract infections, obstruction of the bronchial tubes or throat.

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Diagnosis is by clinical examination , sputum test and taking lung function tests. 

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Asthma attacks vary greatly in frequency, how long they last, and the symptoms. 

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The attacks can range from occasional periods of wheezing, mild coughing, and slight breathlessness to severe attacks that can lead to airway obstruction and total inability to breathe. 

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An attack may begin slowly or abruptly. It is often preceded by an upper respiratory infection. In general, episodes caused by infection begin slowly and last longer. Attacks caused by allergens are sudden and subside quickly if the cause is removed. 

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Typically, an attack begins with shortness of breath, wheezing, and a hacking cough. As secretions increase, breathing out becomes longer. The cough gets deeper and more rattling, and a large quantity of thick sputum is made as the attack lessens. The child appears afraid and speaks in a panting manner. He or she may assume a bent-over position to breath easier. A sudden increase in the rate of breathing, repeated hacking, and coughing without sputum mean a lack of air. This is a medical emergency. 

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Children with life-long asthma develop a barrel chest from the continuous hyperventilated state. They usually carry their shoulders high to make better use of the muscles of breathing.

 

Treatment

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A sudden asthma attack is a medical emergency. 

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It needs direct relief with drugs that widen the bronchi and with removal of excess bronchial secretions. 

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The major drugs used to relieve bronchospasm are the beta-adrenergic agents, the methylxanthines, steroids, expectorants, and sedatives.

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Antibiotics are used when infection is the cause of an attack. 

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Failure to stop the attack results in status asthmaticus. This is a serious prolonged state of breathlessness, needing hospitalization. The child is dehydrated. Thus hospital care includes intravenous fluids and humidified oxygen. Bronchodilators to relieve bronchospasm and antibiotics to reduce risk of infection are also given.

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Children with mild, infrequent attacks are treated with Bronchodilators in aerosol sprays. The sprays give quick relief and are effective in controlling an attack when it begins. The drug may also be  given by mouth in children but is less effective. 

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Those with persistent asthma get daily doses of a bronchodilator by mouth, often theophylline, usually in combination with an expectorant and steroids. These patients may alternatively be given inhalation therapies which is safe and effective

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Sometimes the home environment can be changed to lessen contact with the allergen. Making the patient less sensitive (hypo sensitization) is advised when an allergen is known and cannot be avoided. 

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Physical exercise and play activities are important aspects of therapy, especially those that promote proper breathing techniques.

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Children with emotional problems need special attention. Psychological stresses often trigger asthmatic attacks. For this reason psychotherapy or behavior therapy is often required. 

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Prognosis for children with asthma varies considerably. Many children lose their symptoms at puberty. Much depends on the number and severity of symptoms, emotional factors, and the family history of allergy.

 

 

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