J. zyxwvutsrqponm Paediafr. Child Health (1991) zyxwvutsrq 27, 218-220 Assessment and treatment of childhood asthma R. HENRY, P. SLY, S. GODFREY, P. VAN ASPEREN, R. STAUGAS, P. LE SOUEF, G. SMITH, 1. ROBERTSON, C. ROBERTSON, P. PHELAN, A. OLINSKY, J. MORTON, E. MITCHELL, C. MELLIS, B. MASTERS, J. MARTIN, L. LANDAU, A. KEMP, A. ISLES, M. HARRIS, P. FRANCIS, zyx K. DAWSON, P. COOPER, D. COOPER, I. ASHER and H. ALLEN Abstract In June 1990 a meeting of Paediatric Respiratory Physicians was held near Adelaide. The guidelines for assessing and treating asthma as prepared by the Thoracic Society of Australia and New Zealand for the management of patients with asthma was considered. Although not explicitly stated, these guidelines were designed for adult asthmatics. There was complete agreement that a companion statement was needed to take into account differences between the management of children and adults. This document fulfils that role. Further recommendations are found in a statement prepared by Australian and New Zealand respiratory paediatricians following a workshop in June 1989. This present statement should be read in association with the previous documents.’~2 Key words: asthma; bronchodilators; peak expiratory flow. Childhood asthma is a major burden to children, their families and the community and consumes a large proportion of com- munity health services. Approximately zyxwvutsrq 5O0h of all hospital admis- sions for asthma occur in asthmatics under the age of 15 years; 85% of these are single hospital admissions for asthma within any year. The prevalence of asthma is high in childhood and the majority of children have relatively mild asthma. Only 40% of children who wheeze have four or more attacks per year. The aims of managing paediatric asthma are the same as for managing adult asthma. For example, short term aims include: (i) diagnosing the disease; (ii) restoring normal lung function and abolishing symptoms; and (iii) maintaining the ’best’ lung function for that patient. Aims also include a reduction in the long-term risks of: (i) symptoms that interfere with daily living; (ii) the development of permanently abnormal lung function; and (iii) death from a severe attack. The paediatric asthma management plan can be summarized in six points (Table 1). ASSESSING THE SEVERITY OF THE DISEASE The basis of this assessment is the history and physical ex- amination of the patient. When appropriate, these are supported by lung function measurements such as spirometry and occasionally by peak expiratory flow (PEF) readings at home. Correspondence: P. D. Sly, Children’s Hospital Medical Centre, P.O. zyxwvutsrqp Box D184, Perth. WA 6001, Australia. R. Henry, FRACP. P. Sly, MD, FRACP. S. Godfrey. MD, MRCP. P. van Asperen, MD, FRACP. R. Staugas, FRACP. P. Le Souef, MD, FRACP. G. Smith, FRACP. I. Robertson, FRACP. C. Robertson. FRACP. P. Phelan, MD. FRACP. A. Olinsky, FRACP. J. Morton, FRACP. E. Mitchell, FRACP. C. Mellis, FRACP. zyxwvutsrqponm B. Masters, FRACP. J. Martin, FRACP. L. Landau, MD. FRACP. A. Kemp, MD. FRACP. A. Isles. MD, FRACP. M. Harris, FRACP. P. Francis, FRACP. K. Dawson, MD. FRACP. P. Cooper, MRCP. I. Asher, FRACP. H. Allen, FRACP. Accepted for publication 13 March 1991. Severity of asthma is generally decided by determining whether symptoms are truly episodic or persistent. The following ques- tions are useful to determine whether the child is truly symptom- free between episodes: How often is the child’s sleep disturbed due to asthma? Does the child need a bronchodilator immediately on waking Does the child get exercise-induced cough or wheeze and How many doses of inhaled bronchodilator does your child Those with mild episodic asthma are usually triggered by a viral respiratory infection but any of the known triggers to asthma may be important. Relevant physical examination includes an assessment of growth, signs of hyperinflation and evidence of airways obstruc- tion. Spirometry performed when the child is thought to be in his/her ‘usual’ state may provide useful evidence of airways obstruction at rest and whether or not there is complete rever- sibility after inhalation of a bronchodilator. If there is a fixed component of airways obstruction then an increase in main- tenance therapy should be considered, provided the pulmonary function tests have been performed in a laboratory that caters for the special needs of ~ h i l d r e n . ~ Some children whose background asthma appears mild have life-threatening acute attacks and require referral to a specialist paediatrician for evaluation and management. or can the child wait until breakfast? does it limit hislher activity? take each day beyond the prescribed amount? ACHIEVEMENT OF BEST LUNG FUNCTION Prescribe appropriate therapy The aim is to control symptoms and achieve good lung function without side effects from drugs or disease. Most children with