Pharmacologic Management of Childhood Asthma
Gary S. Rachelefsky MD1
1 Clinical Associate Professor of Pediatrics and Co-Director, Pediatric Allergy Clinic, UCLA School of Medicine, Los Angeles, California
Asthma is characterized by an increased responsiveness of the airways to various stimuli, which results in narrowing of the airways and in a prolongation of the expiratory phase of respiration; in the early phase the airway obstruction is usually completely reversible, either spontaneously or as a result of therapy. There are three therapeutic approaches to asthma: the avoidance of allergens and irritants causing or aggravating the disease; the use of immunotherapy; and the use of pharmacologic agents.
Increasing knowledge of the pathophysiologic aspects of bronchial asthma in the past decade has led to significant advances in its pharmacologic management. The basic alteration of respiratory function is an increased resistance to flow of air through the airway secondary to a combination of three factors: smooth muscle spasm, mucosal edema, and retained viscid secretions. In mild asthma and during remissions the airways less than 2 mm in diameter (the small airways) are obstructed, whereas during an acute attack and with chronicity, both small and large airways are involved. Although both phases of respirations are affected, the increased airway obstruction is more pronounced during expiration.
EVALUATION OF THE ASTHMATIC CHILD
The diagnosis of asthma is based on history, characteristic physical findings and laboratory tests. Asthmatic attacks of infants are usually associated with viral upper respiratory infections; the infants are usually febrile and frequently have otitis media.
