Chronic airway inflammation with recurrent wheeze, cough, dyspnoea; reversible airflow limitation.
History taking
- • Recurrent wheeze, cough (especially night, exercise, cold air), dyspnoea
- • Triggers, atopy, family history, infections
- • Frequency of attacks, ED visits, ICU admissions, missed school
Examination
- • RR, SpO₂, accessory muscle use, wheeze
- • Chest indrawing, silent chest (severe), pulsus paradoxus
Red flags
- • Silent chest, exhaustion, cyanosis, SpO₂ <92%
- • Previous ICU admission, frequent oral steroids
Differential diagnosis
- • Viral wheeze, bronchiolitis, foreign body, GERD, cystic fibrosis, congenital heart disease
Recommended investigations
- • Clinical diagnosis; spirometry from age 5–6
- • PEF diary; allergy testing in selected
Diagnosis
- • Clinical pattern + reversibility (FEV1 ↑12% post-BD)
Initial treatment / management
- • GINA stepwise (paediatric)
- • Inhaled SABA PRN; low-dose ICS as controller
- • Acute attack: salbutamol MDI + spacer 6–10 puffs every 20 min x 3 doses, oral prednisolone
- • Severe: nebulised salbutamol + ipratropium, IV magnesium, admit
Prescription examples
- • Salbutamol inhaler 100 µg with spacer — 2 puffs PRN
- • Budesonide inhaler 100 µg — 1 puff BD with spacer
- • Oral Prednisolone 1–2 mg/kg/day x 3–5 d for exacerbations
Follow-up advice
- • Review 1–2 weeks after exacerbation; control assessment every 3 months
- • Inhaler technique check at every visit
Patient counselling
- • Inhaler technique with spacer (and mask for <4 y)
- • Trigger avoidance, written action plan
- • Vaccinations: influenza, pneumococcal
Referral criteria
- • Severe/uncontrolled despite step-up, diagnostic uncertainty
Clinical pearls
- • Always use spacer in children — improves drug delivery
- • Stepwise approach; reassess control every 3 months
References
- • GINA Guidelines (Children 6–11 yrs) 2024
- • BTS/SIGN British Guideline on Management of Asthma
Educational outpatient guide — verify against local guidelines before clinical use.
