Evaluation of a Child with Asthma | Dr. Vinit Mehta, MD Pediatrician
Introduction
Asthma is one of the most common chronic respiratory conditions affecting children. Proper evaluation and early diagnosis are crucial to managing symptoms and improving the quality of life for affected children. This guide provides a detailed evaluation process for childhood asthma, helping parents understand symptoms, diagnostic methods, and treatment options.
For expert pediatric asthma evaluation and treatment in Vadodara, visit Aashrey Child Clinic. Find Us Here.
Symptoms of Childhood Asthma
Common Symptoms
- Breathlessness: Can occur while walking, at rest, or during feeding in infants.
- Wheezing: A whistling sound during breathing, typically during exhalation.
- Persistent Cough: Especially at night or after exercise.
- Chest Tightness or Pain: More common in older children.
- Fatigue: Resulting from poor sleep due to breathing difficulties.
Severity-Based Symptoms
| Symptom | Mild | Moderate | Severe |
|---|---|---|---|
| Breathlessness | While walking | At rest | Stops feeding in infants |
| Positioning | Can lie down | Prefers sitting | Sits upright |
| Talking | Sentences | Phrases | Single words |
| Alertness | May be agitated | Usually agitated | Drowsy/confused |
| Respiratory Rate | Increased | Often >30 breaths/min | Rapid & labored breathing |
| Wheezing | Moderate, end-expiratory | Loud, throughout exhalation | Loud during inhalation & exhalation or absent in extreme cases |
| Pulse Rate | <100 bpm | 100-120 bpm | >120 bpm or bradycardia |
| Oxygen Saturation (SaO2) | >95% | 90-95% | <90% |
| PaO2 | Normal | >60 mmHg | <60 mmHg (respiratory distress) |
Triggers of Childhood Asthma
- Allergens: Dust mites, mold, pollen, pet dander.
- Irritants: Smoke, strong odors, pollution.
- Infections: Respiratory viruses such as RSV and influenza.
- Exercise & Weather Changes: Cold air, dry air, hyperventilation.
- Comorbidities: Rhinitis, sinusitis, gastroesophageal reflux disease (GERD).
Diagnostic Evaluation of Child with Asthma
1. Medical History
- Frequency and severity of symptoms.
- History of allergies, eczema, or parental asthma.
- Family history of respiratory diseases.
- Previous response to bronchodilators and corticosteroids.
- Environmental factors like smoke exposure or seasonal allergens.
2. Physical Examination
- Auscultation to detect wheezing or diminished breath sounds.
- Observation of accessory muscle use (nasal flaring, chest retractions).
- Assessment of peak expiratory flow (PEF) and lung function tests.
3. Pulmonary Function Tests (PFTs)
For children above 5 years, spirometry helps confirm airflow limitation.
- Forced Expiratory Volume in 1 second (FEV1): Measures lung function.
- Bronchodilator Response Test: Improvement in FEV1 after inhaler use supports asthma diagnosis.
4. Bronchoprovocation Tests
Used for uncertain cases, measuring response to triggers like exercise or cold air.
5. Allergy Testing
Skin prick tests or blood tests (IgE levels) can identify specific allergens.
6. Chest X-ray & Blood Tests
Usually normal in asthma but helps rule out conditions like pneumonia or congenital lung disorders.
Treatment Approaches
1. Inhaler vs. Nebulizer in Asthma Treatment
Read our detailed guide: Nebuliser vs Inhaler in Childhood Asthma
- Inhalers (MDI, Dry Powder): Preferred for daily control.
- Nebulizers: Used during acute exacerbations.
2. Stepwise Medication Approach
| Step | Medication | Indication |
|---|---|---|
| Step 1 | Short-acting beta-agonists (SABAs) | Intermittent asthma |
| Step 2 | Low-dose inhaled corticosteroids (ICS) | Mild persistent asthma |
| Step 3 | Medium-dose ICS or ICS+LABA | Moderate asthma |
| Step 4 | High-dose ICS + LABA | Severe asthma |
3. Long-Term Management Strategies
- Regular follow-ups for medication adjustments.
- Monitoring peak flow to assess lung function.
- Education on avoiding asthma triggers.
- Vaccination against flu and pneumonia to prevent exacerbations.
Frequently Asked Questions (FAQ)
1. How is childhood asthma diagnosed?
Asthma diagnosis is based on medical history, symptoms, lung function tests (spirometry), and response to bronchodilator medications.
2. Can a child outgrow asthma?
Some children may experience a reduction in symptoms as they grow, but asthma can persist into adulthood in many cases.
3. Are inhalers safe for children?
Yes, inhalers are the safest and most effective way to deliver asthma medication with minimal side effects when used correctly.
4. What lifestyle changes help in asthma management?
- Avoiding triggers like smoke, dust, and strong odors.
- Encouraging physical activity but with proper precautions.
- Using air purifiers to reduce allergens at home.
5. When should I consult a pediatrician?
If your child has frequent breathing difficulties, persistent cough, or worsens despite medication, seek immediate medical attention.
Expert Pediatric Asthma Care in Vadodara
Dr. Vinit Mehta, MD Pediatrician, specializes in childhood asthma diagnosis and treatment. For expert consultation, call now: +91 8347990180.
Visit Aashrey Child Clinic for advanced asthma care: Google Maps Guide
📍 Location: First floor, 22, Gyankunj Society-2, above Muthoot Fincorp Gold loan, next to Ajay’s Takeaway food, Near Abhilasha Char Rasta, Raghuvir Nagar, Gyan Kunj II, New Sama, Vadodara, Gujarat 390024.
External Resources
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