Consultant for Pediatricians.
A Guide to Monitoring and Achieving
Asthma Control in Children
Younger Than 5 Years
By KEVIN R. MURPHY, MD
Boys Town National Research Hospital, Omaha, Neb
MICHAEL H. MELLON, MD
Southern California Permanente Medical Group, San Diego, Calif |
September 3, 2009
Dr Murphy is director of allergy, asthma & pulmonology research at Boys Town National Research Hospital in Omaha, Neb. Dr Mellon is an asthma staff
pediatric allergist at Southern California Permanente Medical Group in San Diego, Calif.
HOW CAN CAREGIVERS HELP CHILDREN ACHIEVE ASTHMA CONTROL?
To facilitate asthma control, a detailed written asthma management plan should be provided to caregivers of children with either intermittent or persistent asthma. A plan is especially important for children with intermittent disease and a history of exacerbations because these patients can experience sudden and life-threatening exacerbations.6 The action plan should include specific symptoms indicative of worsening asthma, recommendations for SABA and OCS use, and when to seek medical care.
Once asthma is diagnosed in a child, asthma self-management education should be initiated and continued throughout the child's asthma care. Asthma self-management education provides patients and caregivers with the skills necessary to control asthma and improve symptoms. 6 The goals of therapy should be established between the caregiver and the HCP. Caregivers should be educated on how medications work and on proper device technique. Addressing caregivers' concerns and encouraging treatment adherence are important because caregivers play a major role in establishing and ensuring that the child's asthma is controlled.
After each HCP visit, it is also important for the caregiver to schedule a follow-up visit to continually ensure that the child's asthma is well controlled (Figure 1). The caregiver should ensure that a written asthma action plan is in place at all times and should review it with the HCP at each follow-up visit to determine whether any adjustment to the plan is necessary.6 Caregivers should also note any changes in the severity or frequency of the child's asthma symptoms, especially if wheezing occurs in the absence of a cold or with exercise, and should seek the HCP's advice if such changes are observed.
Case Study: Follow-up
After 4 weeks, Matt returns to the HCP's office for a follow-up visit. According to Matt's mother, his symptoms seem to be controlled. He has had symptoms of coughing and wheezing only once since his last visit and has not required any oral corticosteroids. Matt is sleeping through the night and has been taking his medications as prescribed. His mother reports that he has needed to use his albuterol only once in the past 2 weeks. Matt's PE results are normal. The HCP determines that Matt's asthma is well controlled (Figure 4) and continues to prescribe a nebulized ICS. The HCP reviews the written action plan with Matt and his mother, reviews device technique, and schedules a follow-up appointment in 3 months to review asthma control and medication requirements. Referral is made to the pediatric allergist for definitive allergy testing and collaborative consultation on longterm management.
The diagnosis and treatment of asthma in preschool-aged children is challenging. The role of asthma phenotypes in making treatment decisions for preschool-aged children is a focus of current research. Periodic and ongoing monitoring is necessary to ensure asthma control, defined by the degree to which both the impairment and risk domains of asthma are minimized by treatment. In these children, assessments by clinicians and caregivers are the primary means of monitoring asthma control. Allergy testing is indicated in young children with asthma. TRACK is a new validated and easy-to-administer caregiver completed questionnaire that can be used to aid caregivers and clinicians in evaluating respiratory control in children younger than 5 years with respiratory symptoms consistent with asthma symptoms. The role of TRACK in managing long-term, ongoing asthma is currently being studied. Caregivers have a very active role in managing a child's asthma control. The HCP should provide the caregiver with a written asthma management plan and asthma self-management education. Follow-up at regular intervals is necessary to maintain control of asthma in preschool-aged children.
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