Asthma Management Handbook

Managing asthma in children

Overview

The management of asthma and wheezing disorders in children is based on:

  • confirming the diagnosis
  • assessing the pattern of symptoms (including frequency of episodes and pattern of symptoms between episodes)
  • assessing triggers
  • discussing the goals of management with the child’s parents and the child (depending on age)
  • choosing initial treatment based on the child’s age and pattern of symptoms
  • reviewing and adjusting treatment periodically based on recent asthma symptom control and risk factors (see Figure: Stepped approach to adjusting asthma medication in children)
  • managing comorbid conditions that affect asthma (e.g. allergic rhinitis)
  • providing parents and children with information and skills to manage their asthma, including:
    • a written asthma action plan
    • information about avoiding triggers, where appropriate
    • training in correct use of medicines, including inhaler technique
    • information and support to maximise adherence
  • managing flare-ups when they occur
  • providing advice about avoidance of tobacco smoke, healthy eating, physical activity, healthy weight and immunisation.

In children, initial treatment after making the diagnosis of asthma is guided by the pattern and severity of asthma symptoms. The aims of asthma management are to ensure that the child’s asthma has been correctly diagnosed, and to enable the child to maintain a normal quality of life without interference from asthma or the side effects of asthma treatment.

For children already taking regular preventer treatment, adjustments to the treatment regimen are based on finding the lowest dose of medicines that will maintain good control of symptoms and prevent flare-ups.

Figure. Stepped approach to adjusting asthma medication in children Opens in a new window Please view and print this figure separately: https://www.asthmahandbook.org.au/figure/show/18

Table. Definition of levels of recent asthma symptom control in children (regardless of current treatment regimen)

Good control Partial control Poor control

All of:

  • Daytime symptoms ≤2 days per week (lasting only a few minutes and rapidly relieved by rapid-acting bronchodilator)
  • No limitation of activities
  • No symptoms§ during night or when wakes up
  • Need for reliever# ≤2 days per week

Any of:

  • Daytime symptoms >2 days per week (lasting only a few minutes and rapidly relieved by rapid-acting bronchodilator)
  • Any limitation of activities*
  • Any symptoms during night or when wakes up††
  • Need for reliever# >2 days per week

Either of:

  • Daytime symptoms >2 days per week (lasting from minutes to hours or recurring, and partially or fully relieved by rapid-acting bronchodilator)
  • ≥3 features of partial control within the same week

† e.g. wheezing or breathing problems

‡ child is fully active; runs and plays without symptoms

§ including no coughing during sleep

# not including short-acting beta2 agonist taken prophylactically before exercise. (Record this separately and take into account when assessing management.)

* e.g. wheeze or breathlessness during exercise, vigorous play or laughing

†† e.g. waking with symptoms of wheezing or breathing problems

Note: Recent asthma control is based on symptoms over the previous 4 weeks. Each child’s risk factors for future asthma outcomes should also be assessed and taken into account in management.

Adapted from

Global Initiative for Asthma (GINA). Global strategy for the diagnosis and management of asthma in children 5 years and younger. GINA, 2009. Available from: http://www.ginasthma.org/

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Table. Definitions of ICS dose levels in children

Inhaled corticosteroid

Daily dose (mcg)

Low

High

Beclometasone dipropionate

100–200

>200 (up to 400)

Budesonide

200–400

>400 (up to 800)

Ciclesonide

80–160

>160 (up to 320)

Fluticasone propionate

100–200

>200 (up to 500)

† Dose equivalents for Qvar (TGA-registered CFC-free formulation of beclometasone dipropionate)

‡ Ciclesonide is registered by the TGA for use in children aged 6 and over

Source

van Asperen PP, Mellis CM, Sly PD, Robertson C. The role of corticosteroids in the management of childhood asthma. The Thoracic Society of Australia and New Zealand, 2010. Available from: 
http://www.thoracic.org.au/clinical-documents/area?command=record&id=14

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