PE28.2-5 | Childhood Asthma — Summary & Reflection

KEY TAKEAWAYS

Childhood asthma is chronic variable airflow obstruction driven by Th2 eosinophilic inflammation, bronchospasm, and (in chronic disease) airway remodelling. Diagnosis requires spirometric reversibility (≥12% FEV₁ increase post-SABA) in children ≥5–6 years; clinical Asthma Predictive Index in younger children. Two classification grids must be distinguished: GINA severity (intermittent/mild/moderate/severe persistent — at initial assessment) and GINA control (well-/partially-/uncontrolled — ongoing). GINA stepwise treatment: SABA alone (intermittent) → low-dose ICS (mild persistent) → medium ICS or ICS/LABA (moderate persistent) → medium-high ICS/LABA ± LAMA (severe persistent) → biologics (refractory). ICS is the cornerstone controller; LABA is NEVER monotherapy. Acute exacerbation management: oxygen → salbutamol 0.15 mg/kg nebulisation (every 20 min × 3) → ipratropium 250 µg (moderate-severe) → prednisolone 1–2 mg/kg/day (max 40 mg) or IV hydrocortisone → magnesium sulphate 25–75 mg/kg IV (severe non-responder). PFT indications: diagnosis, severity, monitoring, reversibility, exercise challenge, and acute PEFR grading. Correct inhaler technique is as important as drug selection: pMDI + spacer + mask for <4 years; mouthpiece for ≥5 years; DPI for ≥6–8 years with adequate flow; nebuliser for any age in acute severe. Prevention: ICS controller, trigger avoidance, allergen immunotherapy for atopic cases, annual influenza vaccination.

REFLECT

Return to Arjun from the opening case — the 7-year-old whose near-fatal exacerbation was preceded by 6 weeks of daily salbutamol use with no controller, and whose family was told 'he'll grow out of it'. Consider: what was the GINA severity classification for his chronic disease (daily SABA, likely nocturnal symptoms, no controller), and which step of the GINA framework should have been initiated months before his admission? Now that Arjun is stable after oxygen, nebulised salbutamol × 3 doses, ipratropium, IV hydrocortisone, and magnesium sulphate, what discharge plan — including controller prescription, inhaler device selection for a 7-year-old, and a written asthma action plan — would you give his parents to prevent a second admission? Reflect on how the myth 'children grow out of asthma' causes real preventable harm, and how you will counsel families differently in your future practice.