October 28th, 2013 | Tis the season to get the flu vaccine, but what’s a parent to do if your child has an intolerance or allergy to the flu shot? It’s true that the flu vaccine contains a very small amount of egg protein, but it is still recommended for all children aged six months and older. You may need to take precautions if your child has an egg… Continue Reading
There are many different approaches to asthma management. This is a general overview of the approach taken by our allergy clinic at Riley Hospital for Children. The management approach reflects the most recent National Heart, Lung and Blood Institutes guidelines (2007) for the management and diagnosis of asthma.
The Riley Hospital for Children at Indiana University Health asthma management approach includes:
- Establishing the severity of the condition.
- Establishing the level of control.
- Directing avoidance measures.
- Reviewing written asthma action plans.
- Monitoring lung function.
- Reviewing medication use.
- Reviewing adherence issues.
- Stepping up or stepping down the program as needed.
There are four categories of asthma:
- Mild persistent
- Moderate persistent
- Severe persistent
These categories are defined based on:
- Daytime symptoms
- Nighttime symptoms
- Pulmonary function tests
The categories help with treatment decisions and establish a child’s risks and impairment due to asthma.
Asthma control is defined as:
- Well controlled
- Not well controlled
- Poorly controlled
Control is also associated with risks and impairment. Therapy may change based on the level of control.
Asthma control is linked to the avoidance of those items that trigger flares of the condition. Medications may not work if the environment is hostile to the child.
Asthma management helps with environmental control measures for:
- House dust mites
Avoid these irritants as well:
- Cigarette smoke
- Strong aromas
Exercise can also be a trigger. Knowing how to pretreat and prepare for exercise is important.
ASTHMA ACTION PLANS
Every family is given an asthma action plan that has a daily maintenance program. Additionally, families receive an action plan for an asthma flare and an emergency plan. Plans are gone over in detail at each visit.
MONITORING LUNG FUNCTION
Regular measures of lung function are important in asthma management. In the allergy practice, medical history is evaluated, a physical exam is performed and lung function is evaluated. The physicians discuss lung function results with the family and make plans for what to do until the next visit.
Lung function test results are linked to follow-up evaluations. The frequency of clinic visits depends on the severity category and level of control for the child.
At clinic visits, the physician goes over medication use. The frequency of quick relief or rescue inhaler use can be a measure of asthma control. Possible side effects of medications are discussed. The child’s growth history is also reviewed.
An important part of a successful asthma management program is a measure of adherence (or compliance) with the program. If adherence is an issue, we work out a program that will fit the medical needs and medication use within the constraints of the family and child’s life.
STEPPING UP OR STEPPING DOWN THE PROGRAM
Asthma control can improve or decline over time. There can be long intervals of great control, as well as times of poor control. Home management is discussed at each visit. Plans are made to address the current level of control. If a more aggressive program is needed, a timeline is made to put the new plan in place. Criteria for control are defined and, if needed, a plan for the stepping down process is made.