Regular review pivotal in chronic asthma in children

• Published in: Practitioner Vol. 261; no. 1809; pp. 19 - 23
• Main Authors: Vasi, Veena, Bourke, Thomas
• Format: Trade Publication Article
• Language: English
• Published: London Practitioner Medical Publishing Ltd 01.11.2017
• Subjects: Analgesics; Asthma; Children & youth; Parents & parenting; Patients; Pregnancy; Primary care; Studies; Tobacco smoke
• ISSN: 0032-6518

EVIDENCE-BASED TREATMENT Non-pharmacological management Exposure to environmental tobacco smoke increases wheezing in infancy, risk of persistent asthma, number of exacerbations and need for ICS. There is no evidence that strategies to reduce house dust mite exposure improve asthma control and these should not be recommended.9 A Cochrane review of air ionisers showed no benefit and one study actually showed an increase in cough.10 Two randomised controlled trials on fish oils during pregnancy showed no reduction in asthma or other allergies.3 There are no good quality studies on other supplements during pregnancy. MONITORING The National Review of Asthma Deaths found that 43% of patients who died had had no primary care review in the previous 12 months.2Other risk factors identified included: âeuro¢Healthcare professionals failing to adhere to asthma guidelines âeuro¢More than 12 reliever inhalers in 12 months âeuro¢Underprescription of ICS âeuro¢Inappropriate use of single component LABA In children and young people there was a particular lack of adherence to medical advice and a lack of awareness about the risks of a poor outcome. None 'Parents use the word wheeze to describe a range of respiratory noises but this correlates poorly with objective findings' Table 1 Red flags suggestive of other diagnoses and warrant referral for specialist opinion2 âeuro¢Failure to thrive âeuro¢Abnormal voice, cry or dysphagia âeuro¢Stridor âeuro¢Symptoms from birth âeuro¢Excessive vomiting âeuro¢Severe upper respiratory tract infection âeuro¢Persistent wet cough âeuro¢Family history of unusual chest disease âeuro¢Nasal polyps 'Before stepping up treatment it is essential to reconsider if the diagnosis of asthma is correct' Table 2 Factors to be considered during annual review of children with asthma2 âeuro¢Symptom score, e.g. on the Childhood Asthma Control Test âeuro¢Number of attacks, steroid use and time offschool âeuro¢Inhaler technique âeuro¢Review of prescription refill frequency âeuro¢Review of written personalised asthma action plan âeuro¢Exposure to tobacco smoke âeuro¢Growth (height and weight centile) key points SELECTED BY Dr Matthew Lockyer GP, Suffolk, UK Asthma is a heterogeneous disease characterised clinically by recurrent episodes of wheeze, cough, and breathlessness.