Q&A: Asthma Control in Children

Asthma is a common chronic inflammatory condition of the airways, associated with airway hyperresponsiveness and variable airflow obstruction. The most frequent symptoms of asthma are cough, wheeze, chest tightness, and breathlessness.

This article is for Medical Students & Professionals

This is a Question & Answer revision article designed for medical students and professionals preparing for the PLAB, MRCP or USMLE examinations. They are based on actual questions from these examinations. You may find the Cough article more useful, or one of our many articles on Diseases & Conditions, Medical Syndromes, Health & Wellness or Home Remedies.

In this article:
Aims of long term asthma treatment in children
MCQ exam: clinical scenario
MCQ exam: answers
MCQ exam: explanation

Aims of long term asthma treatment in children

The aim of treatment is to achieve control of asthma. Complete control of asthma is defined as no daytime symptoms, no night-time awakening due to asthma, no asthma attacks, no need for rescue medication, no limitations on activity including exercise, normal lung function (in practical terms forced expiratory volume in 1 second (FEV1) and/or peak expiratory flow (PEF) > 80% predicted or best), and minimal side-effects from treatment.

For children aged over 5 years, NICE (2017) treatment recommendations for children apply to children aged 5–16 years, and adult treatment recommendations apply to those aged 17 years and over. Whereas, for children aged over 5 years, BTS/SIGN (2019) treatment recommendations for children apply to children aged 5–12 years, and adult treatment recommendations apply to those aged over 12 years.

MCQ exam: clinical scenario

An 8 year old boy is newly diagnosed with asthma and is initially treated with nedocromil sodium.

Eight weeks after starting treatment he is seen at the outpatient clinic. His mother complains that her son has remained symptomatic with persistent breathing difficulties and wheezing with physical activity and occasionally complains of tightness in the chest. He has lost four days of school in this period for this reason.

Appropriate treatment at this stage should include:

a) No medical treatment required
b) Nebulised ipratropium bromide
c) Single dose 1 ml 0.5% salbutamol
d) inhaled low dose corticosteroids
e) refer to an ENT specialist

MCQ exam: answers

The correct answer is D.
With the scenario above, inhaled low dose corticosteroids must be included.

MCQ exam: explanations

For children with symptomatic disease and an impaired quality of life, inhaled corticosteroids are, and should remain, the mainstay of asthma control.

Start intermittent reliever therapy with an inhaled short-acting beta2 agonist (such as salbutamol or terbutaline sulfate), to be used as required in all children with asthma. For those with infrequent short-lived wheeze, occasional use of reliever therapy may be the only treatment required. Children using more than one short-acting beta2 agonist inhaler device a month should have their asthma urgently assessed and action taken to improve poorly controlled asthma.

If they remain symptomatic and/or quality of life impaired, then regular preventer (also called maintenance) therapy should be initiated with inhaled corticosteroids, or inhaled corticosteroids as a component.

Reference(s)
1). British National Formulary (BNF): Asthma, chronic. Available online: https://bnf.nice.org.uk/treatment-summary/asthma-chronic.html