Long Term Asthma Management

Children with asthma need a stepwise approach to classify the disease severity and guide treatment appropriately. The number and frequency of medications increase (stepup) as the need for asthma therapy increases and decrease (step down) when asthma is under control.

Persistent asthma is more effectively controlled by long term treatment to suppress and reverse the inflammation than by only treating acute broncoconstriction and related symptoms.

Treatment is reviewed every 3 to 6 months once asthma is under control.

Classification Of Asthma Severity

1. Severe Persistent AsthmaPatients have continuous symptoms with limited physical activity and have frequent night time symptoms. PEF is 60% of predicted with variability more than 30%. Long term preventive treatment include high doses of inhaled corticosteroids 800- 2000 mcg along with anti leukotrines. Also add long acting bronchodilator either inhaled or oral form. Give long term corticosteroid tablets on lowest possible dose on alternate days.

2. Moderate Persistent Asthma
Patients have daily symptoms and attacks affect activity. night time symptoms are more than one time in a week. PEF is 60% less than of predicted and variability is more than 30%. Long term treatment include inhaled corticosteroids 200-500 mcg along with anti leukotrienes.

3. Mild Persistent Asthma

Symptom occur more than once a week but less than once a day. Night time symptoms occur more than 2 times a month. PEF is 80% of predicted with variability less than 20%. Long term treatment includes either inhaled corticosteroids 200- 500 mcg or anti leukotrines. Sustained release theophylline can be used as adjunct therapy.

4. Intermittent Asthma
Patients are asymptomatic and normal between attacks and symptoms occur less than once a week. night time symptoms less than 2 times a month. PEF is 80% of predicted. No long term treatment is needed and only short acting inhaled bronchodilator as needed for symptomatic relief