___________________________________________________________ Asthma: Diagnosis and Management
other agents without consent or supervision by a qualified healthcare provider [8; 11].
asthma symptoms, triggers, and response to treatments. The treatment plan for infants and children younger than 5 years of age is modified according to the specific condition manifestations and treatment limitations specific to pediatrics (Table 3) . In this population, lung function tests are difficult to impossible to administer; therefore, information regard- ing the severity and frequency of symptoms as observed by healthcare practitioners or caregivers may be used to determine the classification of each child’s asthma [9; 10; 31]. As with patients 12 years of age and older, the NAEPP recommends the stepwise management plan be followed according to age groups (0 to 4 years of age and 5 to 11 years of age) (Table 4 and Table 5) [9; 10]. However, the medications and/or dos- ages may vary for this population due to compliance, history, family dynamics, environmental triggers, physiologic response, or medical coverage.
SPECIAL POPULATIONS
ASTHMA IN PEDIATRIC PATIENTS Asthma in pediatric patients may be difficult to diagnose, as children are more susceptible to respiratory viruses and reaction from allergens. Parents or caregivers of children with asthma may suspect the condition is present if the child begins to have repeated episodes of wheezing and coughing with or without illnesses. This is especially true if there is a strong family history of asthma and/or allergies. Parents or caregiv- ers should be encouraged to keep an asthma journal detailing
CLASSIFICATION OF ASTHMA SEVERITY IN CHILDREN YOUNGER THAN 12 YEARS OF AGE Components Intermittent Persistent
Mild
Moderate
Severe
0 to 4 Years
5 to 11 Years
0 to 4 Years
5 to 11 Years
0 to 4 Years
5 to 11 Years
0 to 4 Years
5 to 11 Years
Symptoms
<2 days/week
>2 days/week but not daily
Daily
Throughout the day
Nighttime awakenings 0
<2 times/ month
1 to 2 times/ month
3 to 4 times/ month
3 to 4 times/ month
>1 time/ week but not nightly
>1 time/ week
Often nightly
Short-acting beta 2 agonist use for symptom control Interference with normal activity
<2 days/week
>2 days/week but not daily
Daily
Several times per day
None
Minor limitation
Some limitation
Extremely limited
Lung function
N/A Normal FEV 1
N/A FEV 1 or peak flow >80% predicted FEV 1 / FVC >80%
N/A FEV 1 >60%
N/A FEV 1 <60%
between exacerba- tions FEV 1 or peak flow >80% predicted FEV 1 / FVC >85%
predicted but <80% predicted FEV 1 / FVC 75% to 80%
predicted FEV 1 / FVC <75%
Recommended step for initiating treatment
Step 1
Step 2
Steps 3-4
Steps 5-6
Source: [9; 10]
Table 3
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