BRONCHIAL ASTHMA
With the new normal, we continue our medical education through webinars. Last Monday, I had the privilege of listening to two distinguished speakers on Pediatric Pulmonology and Allergology who revisited bronchial asthma in children. They are Dr. Marysia Recto, a Pediatric Allergologist and Immunologist from the Makati Medical Center and Dr Doris Louise C. Obra, a Pediatric Pulmonologist from Chong Hua Hospital in Cebu City.
Dr. Recto said that Asthma is a chronic inflammatory variable disease with day to day variability in symptoms. Inflammation is central to symptoms and exacerbations. The airways of an asthmatic person may become overly reactive to irritants including smoke, cold and dry air, or allergens.
Also, airways are inflamed and certain triggers may cause constriction thus resulting in exacerbations (asthma attacks). So because of this reason, clinicians need to treat the underlying inflammation to prevent further exacerbation.
Dr. Doris Obra stated that the prevalence of asthma in the Philippines was reported at 10.3% to 26.7% in 2002. There was a high prevalence in urban areas. In the Philippines, the prevalence rates of asthma in children ranged from 9.2% to 27.4%.
Asthma is a pediatric disease. It begins in early childhood and the incidence rates are highest in pre-schoolers.
Furthermore, Dr. Obra presented the asthma management cycle that is to assess, adjust the treatment, and review the response of the patient to the treatment. In the assessment, the child and the parents’ preferences and goals should be met. Initially, there must be confirmation of the diagnosis. Symptoms must be controlled and modifiable risk factors must be identified. Education and skills training is needed in the use of the different ways to deliver treatment of utmost importance. With these, then the response to treatment is attainable thus child and parent are satisfied.
The levels of Asthma symptoms control are categorized into well-controlled, partly controlled, and uncontrolled. It is well controlled when none of the following are present:
- daytime asthma symptoms more than twice a week
- any night waking due to asthma
- SABA reliever needed for symptoms more than twice a week
- any activity limitation due to asthma
It is partly controlled when 1 or 2 of the above mentioned are present and it is uncontrolled asthma when 3 or 4 are present. - Dr. Obra reiterated the definition of asthma exacerbation and that is a progressive increase in symptoms of shortness of breath, cough, wheezing or chest tightness, and a progressive decrease in lung function. This condition represents a change from the patient’s usual status that is sufficient to require a change in treatment.
But not all that wheezes is asthma, so it is still very important to seek early treatment for proper management. - Dear parents, do not self diagnose the cough of your children; do not be complacent on the initial relief afforded by home nebulizations. You have to bring your children to your pediatricians for proper assessment.
Stay safe!