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File 40 Chronic Diseases asthma adult and child
 Chronic asthma (adult & child)
Recommend
 Promote the avoidance of trigger factors along with drug management for
prevention and treatment with a goal of no regular wheeze or cough
Background
 Asthma in children differs from asthma in adults in clinically important aspects,
which include the patterns of asthma, natural history and anatomical factors. The
pattern and severity of asthma in childhood vary widely [1]
Related Topics:
 Acute asthma, page 70
1.
May present with:

Diagnosis of asthma

Symptoms may be seasonal and recurrent, worse at night and have obvious
triggers.

Signs include:

wheeze on chest auscultation

hyper-inflated lungs

spirometry showing reversible airflow limitations
2.
Immediate management – see Acute asthma
3.
Clinical assessment:
 Obtain complete patient history
 family history of asthma, allergies or other risk factors
 history of symptoms and triggers
 medication history
 Perform standard clinical observations +

perform spirometry (FEV1) or peak expiratory flow (PEF) in children over
7 years
 Perform physical examination including:
 auscultate chest for air entry and wheezes

Considerations should be given to the causes of wheeze in young children
[1]
Condition
Characteristics
Transient infant wheezing
Onset in infancy
No associated atopy
Associated with maternal smoking
Cystic fibrosis
Recurrent wheeze and failure to thrive
Inhaled foreign body
Sudden onset
Milk aspiration / cough during feeds
Especially liquids
Associated with developmental delay
Structural abnormality
Onset at birth
Cardiac failure
Associated with congenital heart
disease
Suppurative lung disease
Early morning wet / moist cough
File 40 Chronic Diseases asthma adult and child
4.
Management
Ensure correct use of bronchodilator medication and / devices -check inhaler
technique
 Avoidance of trigger factors
 determine triggers - common trigger factors include animal hair, pollens,
dust, cold air, physical activity, viral upper respiratory tract infections
 Families of people with asthma are particularly encouraged to cease smoking /
not smoke around person with asthma
 Asthma plans
 asthma plans work on the principle of stepping up and stepping down
treatment according to symptoms. They should indicate when to introduce
and remove treatments and when to ask for help. Patients should be
encouraged to be responsible for their illness
 Encourage use of peak flow meters to monitor asthma progress
 Educate the patients / carers of children about:
 ‘treaters’ and ‘preventers’, triggers
Management aims
 Achieve and maintain control of symptoms
 Maintain normal activity levels including exercise
 Maintain pulmonary function as close to normal as possible
 Client and family manages asthma
 Prevent exacerbations
 Avoid adverse effects from asthma medications
 Prevent asthma mortality [2]

DTP
IHW / NP
Authorised Indigenous Health Workers must consult MO and supply under the conditions of the DTP
Nurse Practitioners may proceed
Route of
Recommended
Form
Strength
Duration
Administration
Dosage
Tablet/
As ordered
Oral
As ordered by MO
As ordered by MO
Inhaler
by MO
Short Acting B2 Agonists
Inhaled corticosteroids
Salbutamol (S3)
Beclomethasone
Budesonide
Budesonide
Fluticasone Propionate
Long Acting B2 Agonists
Salmeterol
Combination Iihalers
Eformoterol
Budesonide/Eformoterol
Fluticasone/Salmeterol
Anticholinergics
Ipratropium
Theophylline
Tiotropium
Theophylline SR
Schedule
4
Respiratory Medication
Oral corticosteroids
Prednisolone
Management of Associated Emergency: Consult MO
File 40 Chronic Diseases asthma adult and child
5.
Follow up:
 Asthma 4 x 4 First Aid
 4 puffs of reliever (blue) medication through a spacer
 give one puff at a time
 ask the person to take 4 breaks from the spacer after each puff
 wait 4 minutes
 if there is no improvement give another 4 puffs
 if little of no improvement call an ambulance / health centre immediately.
Keep giving 4 puffs every 4 minutes until help is obtained [1]
 Further follow up according to current edition Chronic Disease Guidelines
Queensland Health and RFDS (Queensland Section) or local protocols if outside
Queensland
6.
Referral / Consultation:
 All children / adolescents with asthma should be reviewed by a MO
 Children and adolescents with severe asthma require specialist referral
 According to Queensland Health current edition Chronic Disease Guidelines or
local protocols if outside Queensland
References
1.
2.
National Asthma Council Australia, Asthma Management Handbook. 2006, National
Asthma Council: South Melbourne.
Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and
Prevention. 2008 [cited 6/4/09]; Available from: http://www.ginasthma.org.