WHAT ARE THE NEXT STEPS FOR A CHILD WITH UNCONTROLLED RESPIRATORY SYMPTOMS?
The HCP should consider coexisting conditions, incorrect diagnosis, new or increased exposures to allergens or irritants, and psychosocial problems that could contribute to suboptimal asthma or respiratory control.6 In children with asthma, inhalant allergens can increase airway inflammation and symptoms. Consequently, reducing a child's exposure to such allergens can significantly reduce asthma symptoms and the need for medications.
The HCP should question caregivers on the child's exposure to allergens such as those associated with pets, mold, moisture or dampness, dust mites, tobacco smoke, unvented stoves or heaters, and medication sensitivities. By using the medical history and skin testing or in vitro testing, with the help of a pediatric allergist, the child's specific allergen sensitivities can be determined. Methods to control asthma by reducing the child's exposure to environmental allergens include removing the pet from the house or, at minimum, keeping the pet out of the child's bedroom, minimizing the child's exposure to tobacco smoke, and closing the windows during periods of peak pollen levels. Aerobiology varies with the region, and molds such as Alternaria are major seasonal causes of asthma in many parts of the United States.
In addition, the evaluation and treatment of comorbidities such as obesity and gastroesophageal reflux disease are important because these comorbidities represent independent risk factors that can increase the severity of childhood asthma and cause poor response to treatment. Assessment of what asthma medications the child is taking and adherence to those medications is also a key component to assessing control. As previously discussed, the HCP should determine whether the child is taking any medications for his/her asthma. If the child is, inquire about dosing; inhaler or nebulizer techniques, if appropriate; and adherence by discussing the child's normal daily routine (Table 6). Consultation with an asthma specialist is recommended for children who need step 3 care or higher and should be considered for those who need step 2 care (Figure 3).