Optimising Asthma Therapy

Not an uncommon question in our clinical practice. But there are some simple basics which helps us to optimise the management in Chronic Childhood Asthma.

When do we call a "Well-Controlled Asthma" in Children ?

• Daytime symptoms less than 2 times in a week/and hence need of reliever is less than 2 times in a week.

• There are no night time symptoms.

• There should be normal activity, play, sports and education.

• There is no visit to hospital due to exacerbation, hospitalisation or need for oral steroids.

What about those who are MART or AIR Regime ?

MART or AIR is usually recommended for children above the age of 12. (MART- Maintenance with Anti-inflammatory and Reliever Therapy. AIR- as and when indicated Anti-inflammatory and reliever therapy).

• All above still applies.

• Infrequent need for extra as-needed ICS–formoterol doses
  Typically ≤2 days per week of additional doses.

• Total daily doses do not exceed the recommended maximum for age/product.

For obvious reasons the changes to medication will depend on the severity of symptoms and their current medications. Before we optimise medications especially escalating treatment remember-

Trigger factors, compliance, inhaler technique and uncommonly we may need to revisit the diagnosis. If necessary there should be consideration to refer to secondary or tertiary care.

Peak Expiratory flow (PEFR) is monitored by many to check Asthma Control, my personal experience has not been very good as I found it not very reliable for various reasons. Spirometry and FeNO are much more helpful.

Written Individualised Asthma Plan for a child is really helpful as it gives an opportunity to educate a child, parents or carers.

I have avoided mentioning the details of medications/doses as it is better to follow the standard recommended guidelines like BTS/NICE and GINA.