Practical Management of Asthma

Pamela Runge Wood; Vanessa L. Hill

doi:10.1542/pir.30-10-375

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Pamela Runge Wood, MD*
Vanessa L. Hill, MD†

^*Clinical Professor of Pediatrics
^†Assistant Professor of Pediatrics, University of Texas Health Science Center, San Antonio, Tex

Objectives

After completing this article, readers should be able to:

Identify the major environmental factors and comorbid conditions that affect asthma.
Describe the role of a written asthma action plan in the management of asthma.
Know how to assess asthma control and adjust therapy appropriately.
Discuss the evaluation and management of the child who has an acute exacerbation of asthma.

Introduction

Despite advances in medical management, childhood asthma continues to be a leading cause of emergency department visits, hospitalizations, and school days missed in the United States. Children afflicted with uncontrolled asthma have difficulty exercising, sleeping, and participating in the normal activities of childhood. Their families may experience financial, social, and work-related difficulties as a result of the child's illness. By working in partnership with families, health-care professionals can help improve asthma outcomes and family functioning. This article reviews the management of asthma. Recommendations discussed in this article are based on the 2007 Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (“2007 Guidelines”). (1) The level of evidence for statements and recommendations is included, when possible. (1)

Initial Assessment

Once asthma has been diagnosed, the physician should determine the degree of severity in the individual patient. Severity is determined best at the time of diagnosis, before initiation of therapy. There are four categories of asthma severity: intermittent, mild persistent, moderate persistent, and severe persistent. The most important distinction is between intermittent and persistent asthma because all individuals who have persistent asthma should be started on long-term control medication. The 2007 Guidelines provide tables for determining asthma severity and initial treatment recommendations for three different age groups: children 0 to 4 years of age, children 5 to 11 years of age, and children 12 years of age and older and adults (Tables 1⇓ to 3).