5 APAPARI 2017 asthma en

APAPARI Workshop Hanoi 2017 Approach to asthma in children Dr Michael Lim Division of Paediatric Pulmonary and Sleep Khoo Teck Puat - National University Children’s Medical Institute (KTP-NUCMI) National University Hospital Singapore 29th April 2017 Definition of asthma Definition of asthma • Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation • Defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation GINA 2015 Definition of asthma • Physiology: Episodic airway obstruction characterised by expiratory airflow limitation • Clinical manifestation: Recurrent wheeze, cough or breathlessness, particularly at night or early morning • Often reversible Definition of asthma • Pathology: Airway inflammation, airway structural changes Stephen T Holgate & Riccardo Polosa Nature Reviews Immunology 8, 218-230 (March 2008) Pathophysiology of asthma Trends in Microbiology, July 2015, Vol 23, No ICON Allergy 2012 Making the diagnosis Pre-school wheezing • Recurrent wheezing occurs in a large proportion of children years and younger • Previous classifications not appear to identify stable phenotypes and their clinical usefulness in uncertain • A diagnosis of asthma in young children with a history of wheezing is more likely if they have:  Wheezing or coughing with exercise, laughing or crying in the absence of respiratory infection  A history of other allergic diseases or asthma in first degree relatives  Clinical improvement during 2-3 months of controller treatment and worsening after cessation Features suggestive of asthma in children