Asthma is the most common respiratory disease seen world over and impacts under five children as well. This article briefly describes the management of children with asthma under 5 years of age.
Why is diagnosis of asthma difficult in children under 5 years of age?
Diagnosis of asthma is difficult in children under 5 years of age due to two reasons. Firstly, many children under 5 years of age have frequent wheezing and other symptoms but have alternate diagnosis or asthma mimics. These could be in the form of gastroesophageal reflux, foreign body aspiration, weakness of the windpipe (tracheomalacia) or bronchi (bronchomalacia) etc. Refer to our blog on “All that wheezes is not asthma”. Secondly, it is difficult to perform lung function tests for young children to confirm asthma diagnosis. Impulse oscillometry can be used in children more than 3 years of age for asthma diagnosis.
What are the goals of asthma treatment in children under 5 years of age?
It has been observed that the quality of life of young kids with asthma and their parents is seriously impacted. Parents of young kids with asthma are stressed, emotionally labile and sleep-deprived. Optimizing the treatment of asthma in young children is important to improve the quality of life of the child and the family.
The goals of asthma treatment in children under 5 years of age are to achieve good control of symptoms like cough, wheezing and breathlessness. The child should be able to participate in all physical activities without any symptoms. Treatment also aims to reduce any asthma flares or attacks which would reduce doctor visits, emergency visits and hospital admissions.
What are the medicines used for treatment of asthma in children under 5 years of age?
Young children with asthma who have frequent symptoms and/or asthma attacks require preventive treatment. The medicines used for preventive treatment should be used daily even if the child does not have symptoms. Inhaled corticosteroids like budesonide and fluticasone are the most effective medicines for asthma treatment. In some children add-on medicines like long-acting beta agonists (salmetrol or formetrol) are used. These medicines are best used with an inhaler and spacer with or without a mask. Use through a nebulizer is not effective. Montelukast can be used for mild cases of asthma but is significantly less effective.
Reliever treatment is also provided for occasional symptoms if any. Children with good asthma control should not require reliever treatment frequently. Salbutamol and levo-salbutamol are the most commonly used relievers. These medicines are also best used with an inhaler and spacer with or without a mask.
What are the most commonly used guidelines for asthma in children under 5 years of age?
The most commonly used guidelines are the GINA or Global Initiative for Asthma and the BTS/SIGN British Guideline on the Management of Asthma. Latest guidelines are freely available through their websites ginasthma.org and nice.org.uk/guidance/ng80.
If your young child is having symptoms suggestive of asthma you need to get in touch with a pediatric pulmonologist for proper diagnosis and treatment.
