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Extra info for Bronchial Asthma in Children: A Clinical, Diagnostic and Management Primer
Patient education about the knowledge of subject, inhaler use, compliance, patient diary, PEF reading, managing an acute attack and visiting the same doctor with file and medications and personal hudsons with tubes, peak-flow meter and spacer. • At each step, patient should be advised to control allergens, irritants and other triggers. • In infants, a diagnostic trial of inhaled bronchodilators and anti-inflammatory medications may be helpful. • Before starting anti-inflammatory therapy for mild persistent asthma, a trial of cromolyn/nedocromil is given for its safety profile.
SYSTEMIC ADVERSE EFFECTS The potential effects of inhaled steroids on children’s growth are important because the drugs are more likely to be used for longer periods although it is well recognised that poorly controlled asthma itself may result in retarded linear growth along with concomitant atopy, asthma severity and male sex. Childhood asthma is associated with delayed maturation and a longer period of reduced growth prior to puberty. A recent meta-analyses do not demonstrate a negative effect on growth with dosages of 400-800 μgm/day.
The second important point would be that even when asymptomatic, the child has to continue therapy as advised viz long-term anti-inflammatory therapy. What would concern a paediatrician would be the child’s growth velocity, daily activities, school absenteeism and side effects of the drugs. Our experience has shown that the child and mother settles very well to the baseline long-term therapy once control is achieved and they are convinced that the child can combat this crippling disease. Hence the goals would be: 1.