Childhood Asthma

A wheezing child has over 80% chances of having asthma. Though wheezing has been considered as a hallmark feature of asthma but it may be associated with other disorders. Recurrent wheezing in infants and children should be considered a diagnostic feature of asthma, but all asthma does not wheeze. Pulmonary function tests (PFT) should be performed to confirm a diagnosis of asthma. Non-wheezing asthma is called ‘occult asthma’. Spasmodic, persistent or recurrent cough may also be a feature of asthma. In the absence of wheezing a diagnosis of asthma may be missed in children. All cases of suspected asthma should be subjected to PFT. The response to asthma therapy can also be assessed with PFT. General pulmonary fitness in-between attacks should be monitored at home or at doctor’s clinic by Peak Expiratory Flow Rate (PEFR) meter. Various precipitating and aggravating factors may differ with age in children and the trend may continue during adult life.

Because of various misconceptions, asthma is highly undertreated disorder in children. Symptoms of asthma may vary with age and asthmatic children always have different clinical patterns. Type and duration of pharmacotherapy appropriate for one pattern may be inappropriate for the other, so it is important both for the physician and the parents of children to understand these patterns.

Childhood Asthma: Pattern-I

Allergic, viral or exercise induced asthma are included in pattern-I. Here the chest congestion with wheezing and breathlessness (bronchospasm) occurs in minutes or hours and rarely lasts for more than a few days. Around 50% percent of all cases of childhood asthma have pattern-I asthma. There may be 1 to 5 episodes per year. The lung functions are near normal and these cases respond well to bronchodilators along with anti-allergic treatment and rarely need steroids.

Childhood Asthma: Pattern-II

Aetiology and features of this type also resemble pattern-I but number of attacks may be 5 to 6 per year. Longer duration of treatment with bronchodilators and sometimes steroids may be required.

Childhood Asthma: Pattern-III

Undertreated children may develop this pattern where overt symptoms of asthma may be variable with impairment of PFT. These children require steroids along with bronchodilators and the course of treatment may be longer.

Childhood Asthma: Pattern-IV

Children with this pattern experience breathlessness without considerable wheezing. Variable but persistent airway obstruction and impaired PFT have been documented in children affected by pattern-IV asthma. These patients need long term treatment with bronchodilators and steroids.

Childhood Asthma: Pattern-V

Children having no symptoms of asthma during the day but having asthmatic attack at midnight or early in the morning should be labeled as the cases of pattern-V asthma. These patients may need aerosol therapy with steroids or beta agonists at night to control the cough and wheezing. Concurrent exposure to various aggravating factors may induce severe effects. Aggravation of symptoms by exercise or a specific allergen should be recognized and reported to the treating physician.