ASTHMA IN CHILDREN

Preceptor : dr. Pulung M. Silalahi, Sp.A

Created by : Yunindar Sevy Arfinta

Clinical Clerckship of Pediatrics Department

Faculty of Medicine, YARSI University
Police Hospitals, Bhayangkara Tk.1 Raden Said Sukanto
Period of 25 April 2017 31 Juni 2017
DEFINITION
ASTHMA IS DEFINED AS A CHRONIC
INFLAMMATORY DISEASE OF AIRWAYS THAT IS
CHARACTERIZED BY INCREASED
RESPONSIVENESS OF THE TRACHEABRONCHIAL
TREE TO A MULTIPLICITY STIMULI
PREVALENCE

Most of people With

with ssthma in 250.000
300 million annual
people suffer Indonesia
suffered by the deaths
from ashtma attributed
middle-lower
ecenomic class to the
disease
RISK FACTOR OF ASTHMA
PATHOGENESIS OF ASTHMA (cont)

Stimul
i that
Allergenic
incite
asthm Pharmacologic
a:
Environmental
Occupational
Infectious
Exercise-related
Emotional
Inflammatory processes
Desquamation of
epithelium

Hyperplasia of Mucus plug

Mucos glands

Basement
Membrane
thickening

Oedema
Neutrophil and
Smooth muscle eosinophil infiltration
Hypertrophy and contraction
 CLASSIFICATION

Clinical Parameters, Need Episodic Asthma Rarely Episodic Asthma Often Episodic Asthma Persistent
For Medicine And Physiology
Lung

Frequency < 1x/Month > 1x/Month Often

For A Long Time Attack < 1 Week 1 Week Almost All Year Round, There Is No
Remission

Attack Intencity Mild Moderate Severe

Sleep And Activity No Yes Yes

Theraphy No Yes Yes

(Antiinflamasi)

Test Faal Paru (Diluar Pef/Fev1 >80% Pef/Fev1 60-80% Pef/Fev1 <60%
Serangan) Variabilitas 20-30%

Variabilitas Faal Paru (Bila Variabilitas >15 % Variabilitas >30% Variabilitas >50%
Ada Serangan)
CLINICAL FEATURES

The symptoms of asthma consist of :

Dyspnea
Cough
Wheezing

Other clinical features :

Constriction in the chest

Often with non productive cough
Respiration becomes audibly harsh
Wheezing in both phases of respiration becomes prominent
Expiration becomes prolonged
Patients frequently have tachypnea
Tachycardia and mild systolic hypertension
The lungs rapidly become overinflated and the diameter of
the thorax increases
CLINICAL FEATURES (cont)

When the astma becomes severe, there are

more sympthom we can found:

The Accessory muscle (specially SCM muscle) become

visibly active, and a paradoxical pulse often develops.
If the patients breathing is shallow, this sign and/or the use
of accesory muscles could be absent even though
obstruction becomes severe.
Cyanosis
Silent chest.
Decrease alteration
Patient looks very tired
Chest Hyperinflated
Tachycardia
DIAGNOSIS

Anamnesis
DIAGNOSIS

Physical Examination

Wheezing on auscultation
Cyanosis
Drowsiness
Difficulty speaking
Tachycardia
Hyperinflated chest
Use of accessory muscles
Intercostal recession
DIAGNOSIS

Tests for Diagnosis

Measurements of lung
function
Measurement of airway
responsiveness
Measurements of allergic
status
Non-invasive markers of
airway inflammation
PEAK FLOW
METER

Child with mini peak flow meter. Measurement of peak flow at home is the
most reliable assessment of the degree of asthma a patient is suffering from.
Asthma affects a wide age span, from the first few years of life to the eighties
or nineties. Peak flow measurements can be measured by 4-year-olds but
can present problems in the 80-year-olds. Recording of results may be
difficult in the young and co-operation of the parent may be needed.
TREATMENT

1. Quick Relief Medications

Adrenergic stimulant:
Short acting : catecholamine (epinephrin,
isoprotenol, isoetharine)
Long lasting : terbutaline, fenoterol (resorsinol),
albuterol (saligenin)
Methylxanthines : Theophylline
Anticholinergic : Ipratropium Bromide
TREATMENT (cont)

2. Long-term Controller Medications

Glucocorticoid : inhaled glucocorticoid

Long acting Beta agonist : salmeterol,
formoterol
Combined medications : inhaled
steroid+long acting beta agonist
Mast cell-stabilizing agent : cromolyn
sodium, nedocromil sodiume.
Leukotriene modifiers :
Inhibit 5 Lipoxygenase
Competitive antagonist LTD4
Methylxanthines
LONG TERM TREATMENT
FRAMEWORK FOR MANAGEMENT OF
CHRONIC ASTHMA

The GOAL of chronic therapy :

Achieve a stable, asymptomatic state with the best

pulmonary function possible using the least amount
of medication.

The specific recommendations :

Minimal or absent daytimer nocturnal chronic

symptoms
Minimal or absent exacerbation
No limitation of activities
No absences from school or work
The minimal use of short-acting 2-agonist
Minimal or absent adverse effects from medications
ASTHMA TREATMENT IN SOCIETY

Swimming

Especially for children. Swimming constantly helps stabilizing breathing pattern.

Aerobic

Objective : controlling breathing

Relaxation
reducing accessory muscle breathing tension
reducing energy consumption for breathing
Lower chest breathing exercise

Controlling the environment around asthma patient

avoid humidity
adequate ventilation
adequate sunscreen
clean the rooms especially bed room regularly to avoid dusts
avoid pets
Use mattress made from latex, but not kapok to avoid mites
Avoid inhaling harmful gases (cigarrette smoke, insect spray, etc)
PREVENTING ASTHMA IN
CHILDREN

In order to prevent Asthma

Nutrition
Breast Feeding
Vitamin D
Delayed Introduction of Solid
Probiotics
Inhalant Allergen
Pollutants
Microbial Effects
Medications and other factors
Psychosocial factors
PROGNOSIS AND CLINICAL COURSE

The mortality rate from

Good prognosis
asthma is small.

Spontaneous remissions occur

in approximately 20% of those
who develop the disease as
adults, and that 40% can be
expected to experience
improvement, with less
frequent and severe attacks,
as they grow older.