What are the effects and signs?
There is no gold standard definition of asthma and diagnosis is based on symptoms and response to treatment. Typically asthma symptoms will occur intermittently -:
- Wheezing especially at night and early in the morning
- Coughing at night
- Chest tightness
- Difficulty breathing
These symptoms are likely to get worse or only be present when the child has a cold. For the purposes of this guidance, mild to moderate asthma will be discussed together and severe asthma will be described and considered separately. Children with asthma under 5 years of age will be described separately from children aged 5 and over.
Asthma is a condition that can be controlled with medication, using the least amount of medication to control symptoms is the aim of treatment. This reduces the risk of side effects. Beneficial effects of treatment always outweigh side effects.
The management of asthma is a step wise process. Each step up in treatment is designed to gain better control of asthma symptoms and enable a normal life with normal exercise tolerance and undisturbed sleep. Clear guidelines on asthma have been produced by the Scottish Intercollegiate Guideline Network (SIGN).These are widely used across primary and secondary care in the UK. The steps are described in detail in this section, as treatment used will give a clear indication of what step of treatment a child is on, how severe their asthma is and whether there are likely to be any resulting care needs. The step or stage of asthma according to these guidelines may also be given in any accompanying medical evidence.
Other respiratory conditions claimed as ‘Asthma’
Asthma is a very common respiratory condition; any condition affecting the lungs is likely to cause difficulty breathing and coughing and at first may appear to be asthma. Children who fail to improve with asthma treatment or who appear to have more severe or worsening asthma are likely to have further investigations for an underlying lung condition. The underlying condition may be identified after a period of asthma treatment. Examples of such conditions include cystic fibrosis, goodpasture’s syndrome, bronchiectasis and many others. If another respiratory condition is identified, asthma guidance is not appropriate.
Other conditions which increase care needs related to asthma i.e. care needs present in mild to moderate asthma can be -:
- Any diagnosed behavioural condition which makes compliance with treatment on a daily basis difficult or prolonged.
- Severe allergy with history of anaphylactic shock (severe reaction) – particularly if allergen can be inhaled and is a common environmental contaminant
- When asthma is one of a number of conditions which in combination require extra care and attention on a daily basis.
