Stepwise Treatment of Asthma
By Kathleen MacNaughton, R.N
The approach to treatment of asthma in children in many ways is similar to asthma treatment approaches for adults. However, kids’ asthma treatment is modified by age group, as recommended by the National Expert Panel Guidelines for Asthma Treatment. It also makes greater use of the stepwise approach to treatment of asthma, due to the greater variability in asthma status among kids.

The Expert Panel stresses that the goal of asthma therapy in kids is to maintain long–term control of asthma with the least amount of medication and hence minimal risk for adverse effects. They also talk about preventing asthma from worsening, or progressing, in children.

How Asthma Control Is Measured
Asthma control is measured both by impairment and risk.

Asthma impairment reduction is defined as

• Chronic and troublesome asthma symptoms, such as coughing or feeling breathless in the daytime, in the night, or after exertion, are prevented.
• Rescue inhalers are used for quick relief of asthma symptoms less than twice a week.
• Healthy pulmonary function is maintained.
• Usual activity levels, including school attendance and participation in sports and play activities, is possible.
• Child and parents are satisfied with asthma care.

Asthma risk is reduced as follows

• Repeat asthma flare–ups are prevented, thus minimizing the need for emergency care or hospitalization.
• Healthy lung growth occurs, with no worsening of airway function.
• Effective medication treatment occurs without serious or bothersome side effects.

Distinguishing between impairment and risk emphasizes the complex nature of asthma treatment and its effects on both quality of life, as well as physical functioning.

Diagnosing Asthma in Kids Is the First Step
Before asthma treatment in children can begin, however, a diagnosis of asthma must be made. This is not as easy as it sounds. Asthma is often misdiagnosed in kids, which is what happens when their asthma–similar symptoms don’t really add up to asthma. Or, they may also be underdiagnosed, when instead of the correct asthma diagnosis, they are labeled as having wheezy bronchitis, sinusitis, reactive airway disease, respiratory infections, or something else.

Complicating factors is that children – especially very young ones – can’t always communicate well enough about how they are feeling or what they are struggling with. Some pulmonary function tests that can help nail down an asthma diagnosis are also not able to be used in young children. Doctors often have to rely solely on their physical exam of the child and the parents’ observations. Or, in some cases, they may give asthma medications for a trial period to see what happens. If symptoms improve when taking asthma medications, an asthma diagnosis may be more likely.

The problems with kids not getting the right diagnosis can be twofold

• Kids who are diagnosed in error as having asthma may be treated with the wrong medications for long periods of time and put at unnecessary risk.
• Kids who DO have asthma do not receive the treatment they need to maintain healthy lung function. As a result, their airways get worse and quality of life declines.

So, it’s important that kids who have asthma be diagnosed correctly and started on treatment as soon as possible.