Asthma: What's New, and What Should Be Old But is Not!
Asthma is a common condition, which is commonly, badly diagnosed and badly treated, leading to unnecessary morbidity and even death in childhood, despite which complacency about management at all levels of care persists. Asthma is an umbrella term like anaemia and arthritis and should not be used as...
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Wolters Kluwer Medknow Publications
2017-01-01
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| Series: | Pediatric Respirology and Critical Care Medicine |
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| Online Access: | https://journals.lww.com/10.4103/prcm.prcm_11_16 |
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| author | Andrew Bush |
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| collection | DOAJ |
| description | Asthma is a common condition, which is commonly, badly diagnosed and badly treated, leading to unnecessary morbidity and even death in childhood, despite which complacency about management at all levels of care persists. Asthma is an umbrella term like anaemia and arthritis and should not be used as an unqualified diagnosis. It is suggested that airway disease should be deconstructed into treatable and untreatable components, such as fixed and variable airflow obstruction and airway inflammation and infection. Every effort should be made to make an objective diagnosis, and treatment should be individualised accordingly. Objective testing for airway inflammation may include determination of atopic status, blood eosinophil count and exhaled nitric oxide; physiological testing includes peak flow measurement, comprising response to exercise and short-acting μ-2 agonists. Most school-age atopic children with recurrent wheeze respond well to low-dose inhaled corticosteroids if these are regularly and correctly administered. The provision of an asthma plan is mandatory. If response is poor, rather than uncritically escalating therapies, a review of adherence and any adverse environmental factor should be considered. Asthma attacks are a red flag sign of a bad prognosis, and should prompt a full review, and changes in the asthma plan as necessary. Also, regular reviews of progress and treatment need are mandatory, even in the well child with asthma. In all contexts, the importance of getting the basic rights cannot be overemphasised; still, asthma deaths are attributed to neglect of this principle. Other issues discussed in this review include the approach to the child who is breathless on exercise and the diagnosis of exercise-induced laryngeal obstruction; the so-called habit/honk cough; the problem of breathlessness and airway disease in the obese child, including the airway as the target of systemic inflammation; and the problem of 'asthma' complicating other airways diseases such as cystic fibrosis and extrapulmonary diseases such as sickle-cell anaemia. Overall, the main message of this review is that it should never be forgotten that asthma is a disease which kills children and should always be taken seriously. |
| format | Article |
| id | doaj-art-eeef81f66e464c22941c5181b7b3142c |
| institution | DOAJ |
| issn | 2543-0343 2543-0351 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Pediatric Respirology and Critical Care Medicine |
| spelling | doaj-art-eeef81f66e464c22941c5181b7b3142c2025-08-20T02:56:01ZengWolters Kluwer Medknow PublicationsPediatric Respirology and Critical Care Medicine2543-03432543-03512017-01-011121010.4103/prcm.prcm_11_16Asthma: What's New, and What Should Be Old But is Not!Andrew BushAsthma is a common condition, which is commonly, badly diagnosed and badly treated, leading to unnecessary morbidity and even death in childhood, despite which complacency about management at all levels of care persists. Asthma is an umbrella term like anaemia and arthritis and should not be used as an unqualified diagnosis. It is suggested that airway disease should be deconstructed into treatable and untreatable components, such as fixed and variable airflow obstruction and airway inflammation and infection. Every effort should be made to make an objective diagnosis, and treatment should be individualised accordingly. Objective testing for airway inflammation may include determination of atopic status, blood eosinophil count and exhaled nitric oxide; physiological testing includes peak flow measurement, comprising response to exercise and short-acting μ-2 agonists. Most school-age atopic children with recurrent wheeze respond well to low-dose inhaled corticosteroids if these are regularly and correctly administered. The provision of an asthma plan is mandatory. If response is poor, rather than uncritically escalating therapies, a review of adherence and any adverse environmental factor should be considered. Asthma attacks are a red flag sign of a bad prognosis, and should prompt a full review, and changes in the asthma plan as necessary. Also, regular reviews of progress and treatment need are mandatory, even in the well child with asthma. In all contexts, the importance of getting the basic rights cannot be overemphasised; still, asthma deaths are attributed to neglect of this principle. Other issues discussed in this review include the approach to the child who is breathless on exercise and the diagnosis of exercise-induced laryngeal obstruction; the so-called habit/honk cough; the problem of breathlessness and airway disease in the obese child, including the airway as the target of systemic inflammation; and the problem of 'asthma' complicating other airways diseases such as cystic fibrosis and extrapulmonary diseases such as sickle-cell anaemia. Overall, the main message of this review is that it should never be forgotten that asthma is a disease which kills children and should always be taken seriously.https://journals.lww.com/10.4103/prcm.prcm_11_16atopycougheosinophilexercise-induced laryngeal obstructionexhaled nitric oxideobesitypeak flow |
| spellingShingle | Andrew Bush Asthma: What's New, and What Should Be Old But is Not! Pediatric Respirology and Critical Care Medicine atopy cough eosinophil exercise-induced laryngeal obstruction exhaled nitric oxide obesity peak flow |
| title | Asthma: What's New, and What Should Be Old But is Not! |
| title_full | Asthma: What's New, and What Should Be Old But is Not! |
| title_fullStr | Asthma: What's New, and What Should Be Old But is Not! |
| title_full_unstemmed | Asthma: What's New, and What Should Be Old But is Not! |
| title_short | Asthma: What's New, and What Should Be Old But is Not! |
| title_sort | asthma what s new and what should be old but is not |
| topic | atopy cough eosinophil exercise-induced laryngeal obstruction exhaled nitric oxide obesity peak flow |
| url | https://journals.lww.com/10.4103/prcm.prcm_11_16 |
| work_keys_str_mv | AT andrewbush asthmawhatsnewandwhatshouldbeoldbutisnot |