Asthma is the most common respiratory disorder of children. Chronic inflammation of the bronchial mucosa and hyper reactive airways results in broncho constriction and reversible airway narrowing. It typically presents with wheeze, dry cough, difficulty breathing and/or chest tightness.
Managing childhood asthma involves both an appreciation of current treatment practice but also a willingness to educate and support the child and their family in the longer-term. Different phenotypes of childhood asthma are increasingly being recognized.
Transient early wheezers where wheezing is commonly associated with viral upper respiratory infections. This is most likely to be grown out of by about 3 years, particularly in those children without a family or personal history of atopy.
Non-atopic wheezers who again are likely to outgrow symptoms by early school age. Children who go on to develop a more persistent, atopic asthma, associated with raised immunoglobulin E (IgE) levels. Acute asthma Acute asthma is a relatively common paediatric emergency. 40 UK deaths due to asthma in the 0-14 years' age range were recorded in 2006, which underlines the necessity to treat acute asthma as severe until proven otherwise and to refer children who respond inadequately to community treatment urgently to hospital.
Presentation It is vital to recognize the severity of an acute asthma attack. Clinical signs are a poor indicator of the degree of airways obstruction and some with acute severe asthma may not appear distressed.
Always assess and record: Pulse rate.
Degree of breathlessness (eg ability to complete sentences, to feed).
Use of accessory muscles of respiration (feel the neck muscles for involvement in breathing).
Amount of wheezing (with increasing severity, wheeze may become biphasic or less apparent).
Degree of agitation and conscious level.
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