How long will the needs last?

Asthma Duration Guidance

Under 5

Care needs may be present under age 5 because of the time taken to administer asthma treatment in this age group. This will depend less on the severity of the asthma than the behaviour of the child and the difficulty of administering daily treatment to control the disease.

By 5 years of age, child behaviour and ability to co-operate with asthma treatment is much improved. Care needs may be substantially reduced.

At age 5 a renewal with fresh medical evidence will be needed.

5 and over

The majority of children have mild asthma and will have no care needs. Children aged over 5 are likely to have care needs when asthma is severe and difficult to control. These children constitute 2-5% of children with asthma in the UK. Such children will always be managed in secondary care by either a Consultant Paediatrician or a Consultant Respiratory Paediatrician in a regional centre.

They are likely to have multiple courses of oral steroids each year to control asthma exacerbations and be on multiple regular medications in-between. Ensuring multiple drugs are available and taken several times a day, recognising when asthma is uncontrolled and seeking medical help is the care required. The medication will need to be stepped up and down to control exacerbations. Drugs used are likely to include some of the following -:

• High dose inhaled steroids,
• LABA
• leukotriene inhibitors (tablets)
• theophylline
• azathioprine
• subcutaneous terbutaline infusion

Monitoring will be regular and frequent, with the need to interpret Peak Flow Monitoring charts to modify medication regimes to avoid severe exacerbations of asthma and hospital admission. Exacerbations are likely with every cold and children with severe asthma have these 6-8 times a year. Such children will be able to manage their own complex monitoring/medication needs from the 12th birthday. Those on terbutaline subcutaneous infusion pumps or other drug infusions for asthma control would be expected to manage this from the 14th birthday.

Children with needs identified aged 5 and over are likely to require care until age 12, by which time they will have been taught how to manage their asthma themselves. The exception to this is children using subcutaneous pump treatment. They are likely to require extra care until age 14, at which age they can be expected to manage their treatment themselves.

Children with other conditions in addition to asthma such as learning difficulty or behavioural disorder may not be able to manage their treatment at these ages without help and supervision, duration guidance here does not apply to them, assess each case individually.

Brittle or very unstable asthma

A very small number of children (less than 1000 in the UK) will have been advised not to go anywhere without adult supervision or supervision from a child older than 14 because of their propensity to have life threatening asthma attacks within a few minutes of inhaling asthma triggers or allergens.

These children may need help until age 14. From that age onwards they can be expected to recognise an asthma attack and act accordingly to get help. If the child cannot do this, then they will continue to need help. Confirmation of such attacks should be obtained from the Clinical Nurse Specialist or treating Paediatrician and duration of award details discussed with Medical Services.

All information must be taken into account when considering the duration of care and mobility needs. The duration of care and mobility needs must be based on the particular circumstances of the child.