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Continuity Clinic Notebook:

 Chapter II. The Evaluation of the Sick Child

Chapter 2 Index

A. Evaluation by system:

1. General

2. HEENT

3. Cardiopulmonary
--Heart Murmurs: When to Refer
--How to Feed Infants with Heart Disease
--Syncope in the Pediatric Age-Group

  

Asthma: Classification and Management

Introduction: Asthma is the most common chronic illness that affects children. It has been recommended that pediatricians follow the 1997 NIH guidelines for dx and rx.

Classification:

  Mild Intermittent Mild Persistent Mod Persistent Severe Persistent
Symptoms < 2 / week > 2 / week Daily Continual
Night sx < 2 / month > 2 / month > 1 / week Frequent
FEV1 > 80% predicted > 80%predicted 60-80% < 60%
Peak flow Variability < 20% 20-30% > 30 % > 30%

Management  of different categories of Asthma:

  Mild Intermittent Mild Persistent Mod Persistent Severe Persistent
Peak Flow Meter                 X       X
Preventive Meds (daily):
--Inhaled Cromolyn   X (X)  
--Inhaled Steroids   X (low dose) X (med dose) X (high dose)
--Po Singulair   X X X
--Advair Diskus     X X
--Serevent     X X
Rescue Medications
--Albuterol X X X X
--Po Prednisone prn Prn Prn prn
 Skin Testing: Allergy Evaluation    Consider  Consider  Consider
Trigger Identification X X X X

Examples of different therapeutic approaches:

  1. Mild Intermittent: use only prn albuterol; if related to exercise, use albuterol one-half  hour prior to exercise; also used: cromolyn one half-hour prior to exercise.
  2. Mild Persistent: daily: low dose inhaled steroids; and use albuterol intermittently as needed.  Also may use po singulair or inhaled cromolyn.
  3. Moderate Persistent: use peak flow meter daily; use med dose inhaled steroid or low dose steroids plus serevent or singulair.  Others switch to Advair. PO steroids prn.
  4. Severe Persistent: use peak flow meter daily; po steroids as needed.  Daily meds to include high dose inhaled steroids, singulair, serevent or possibly Advair.

Method of Delivery of Inhaled Meds: Multiple studies showing MDIs are equal to or superior to jet nebulizers. If use latter, try always to have parents use a mask.  If MDIs frighten young children, may need to use jet nebs until older. 

Dosage of medications: see Asthma Medications.                          

Written 3/02

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Department of Pediatrics  |  Medical College of Georgia
 Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004