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Archive for the ‘ASTHMA’ Category

Acute bronchiolitis

Andrew Bush, professor of paediatric respirology. BMJ  2007;335:1037-1041 (17 November).

Acute bronchiolitis is a clinical diagnosis. It “is a seasonal viral illness, characterised by fever, nasal discharge and dry, wheezy cough. On examination, there are fine inspiratory crackles and/or high-pitched expiratory wheeze.

Summary points:

• Bronchiolitis caused by respiratory syncytial virus is an important and seasonal cause of respiratory morbidity in the first year of life
No effective preventive or therapeutic strategies exist, and supportive management is offered
Unnecessary investigations and ineffective treatment must be avoided
Many infants have medium to long term post-bronchiolitic symptoms, which should not be confused with true asthma and which do not respond to any current treatments

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Management of asthma in children
By: M Mckean, consultant in respiratory paediatrics BMJ 2007;335:253-257 (4 August)

An exacerbation of asthma can occur at any time and in childhood is most commonly precipitated by viral upper respiratory tract infections.

The management of episodic viral wheeze is controversial. Currently, the indiscriminate use of anticholinergics and short acting 2 agonists in the management of acute episodic viral wheeze is not recommended. Although these agents are still used for young children with wheeze, the doctor should ensure that a clear clinical benefit is achieved before they are regularly prescribed.

Summary:

  1. Inhaled corticosteroids, although safe if given at the recommended dose, can have important adverse effects if given above it, including adrenal suppression
  2. Long acting 2 antagonists can be used as add-on treatment to avoid further increases in the dose of inhaled corticosteroid but can be associated with increased risk of exacerbations and hospital admission
  3. Long acting 2 antagonists should therefore be continued only if a demonstrable response to treatment occurs
  4. Inhaled corticosteroids do not prevent the development of asthma
  5. Low dose inhaled corticosteroid should not be used as preventive treatment for episodic viral wheeze
  6. Referral to a specialist centre should be considered when a child reaches step 4 of the British Thoracic Society/Scottish Intercollegiate Guidelines Network guideline or earlier, depending on the expertise of the general practitioner and the resources available

Read more about asthma in children AND JUST CLICK HERE.

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