Dr Kerry Hancock
Chair, GP Asthma Group, National Asthma Council Australia
Colds and flu can be serious for children with asthma
As winter sets in, cold and flu viruses abound. For our younger patients with asthma this is an especially difficult time of year, with respiratory viruses being a major cause of asthma exacerbations in children.
 Intermittent exacerbations – particularly those due to upper respiratory viral infections – can occur in children with stable asthma despite good ongoing overall asthma control.1
Managing exacerbations
Exacerbations in children associated with viral infections do not necessarily indicate a failure of preventer therapy, nor do they warrant an automatic step up to higher inhaled corticosteroid (ICS) doses or a progression to combination therapy. Children taking regular preventative medicine should stay on the same dose during an exacerbation. Doubling the ICS dose is ineffective.1
If a child is experiencing an exacerbation, reliever medications should be recommended and administered via a puffer (MDI) and spacer. This treatment is equally as effective as nebulisation in children with moderate to severe acute asthma.2 Parent or practitioner initiated oral corticosteroids should be reserved for severe exacerbations.1
As the exacerbation is brought under control, it is imperative to always review adherence and inhaler technique to ensure that the prescribed drug is actually getting to where it needs to be.
Written asthma action plans
A comprehensive written asthma action plan for recognising and managing acute episodes is vital for both children and their parents – and not only during winter but throughout the year.
Indeed, a large proportion of the serious asthma related paediatric emergencies in winter could probably be prevented if asthma action plans were adhered to. Many asthma action plan templates are available; see the National Asthma Council Australia (NAC) website for examples. In children, symptom based plans are preferred.
Remind parents that a copy of the completed action plan should also be given to their child’s grandparents, sports coaches or other regular carers.
Flu vaccination
Current Australian immunisation guidelines now recommend influenza vaccination for all children older than 6 months who are at risk of severe complications, which includes kids with asthma.3
Children 9 years of age and under who have not been previously vaccinated should receive two doses 1 month apart in the first year they get vaccinated; in subsequent years, they only require one dose. Children younger than 3 years of age need a lower dose (0.25 mL); once they reach 3 years of age, they should be given the adult dose (0.5 mL).
Reliable online resources
Finding time to provide comprehensive education for children with asthma and their families can be challenging.
With this in mind, a new child friendly website has been launched by the NAC to give children with asthma and their parents reliable information on asthma, including guidance on diagnosis, medications, triggers and management. Visit the website at http://www.kidswithasthma.com.au/.
The Kids With Asthma medical content was developed by an independent NAC expert panel led by Professor Peter van Asperen, a paediatric respiratory physician, with the support of an unrestricted educational grant from website publisher Merck Sharp & Dohme.
For information on asthma diagnosis and management, including asthma action plan templates, visit the NAC website at www.nationalasthma.org.au. The NAC’s recent panel discussion program, ‘A is for Asthma: Managing asthma in primary school kids’, is now available via the NAC website or from the Rural Health Education Foundation at www.rhef.com.au.
References
1. National Asthma Council Australia (NAC). Asthma Management Handbook 2006. Melbourne: NAC, 2006.
2. Cates CJ, Bara A, Crilly JA, Rowe BH. Holding chambers versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev 2003;(3):CD000052.
3. National Health and Medical Research Council (NHMRC). The Australian Immunisation Handbook. 9th edn. Canberra: NHMRC, 2008. Available at www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-influenza [Accessed April 2009].
Acknowledgement
Fighting the flu season
Originally published in GP Review, May 2009. Reproduced with permission.
Download a PDF of this article from the GP Review website: http://www.racgp.org.au/gpreview/200905/32416
Content Updated May 2009
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