Tariq is a seven year old boy who has had a history of eczema and asthma since early childhood. According to Guibas et al (2012) asthma is the most common chronic respiratory disease of childhood: its prevalence has been rising in the western world for the last three decades. In Scotland, 368,000 people (1 in 14) are currently receiving treatment for asthma. This includes 72,000 children and 296,000 adults. There are 5.4 million people living with asthma in the UK and around 1 million of these are children aged 16 years and younger. Asthma UK. (2008)
At Tariq’s latest asthma review; it is found that he is using his reliever inhaler more often. Tariq’s mother expresses disappointment about this as she was hoping Tariq would grow out of his asthma. Jose et al (2013) highlight the fact that in older children the level of asthma control is overestimated and conversely the impact asthma has on the everyday life of the child underestimated. They argue this is partly due to the difficulty of correctly assessing symptoms and also to the extent to which the child has adapted their lifestyle in order to avoid them.
The following discussion will attempt to address not only Tariq’s immediate asthma needs, but also his longer term management and if in fact he has simply been coping with his symptoms up until now by adapting his lifestyle.
Careful explanation and education will also be required to alleviate his mother’s concerns. Initial assessment
A validated tool such as 'The Royal College of Physicians (RCP) three questions’ should be used to complete a thorough initial assessment to ensure Tariq is not currently having an asthma exacerbation as broad non-specific questions may underestimate the symptoms. In the last month:
1 Have you had difficulty sleeping because of asthma symptoms (including cough)? 2 Have you had your usual asthma symptoms during the day (cough, wheeze, chest tightness or breathlessness)?
3 Has your asthma interfered with your usual activities e.g. housework work, school, etc. Other questions can include those as in, Sign Guidelines for children (2011) 1 Whether your child has had an asthma attack since their last review and if so how many. 2 How many courses of steroid tablets your child has had since their last review. 3 Whether your child has had any time off school or nursery because of their asthma since their last review. 4 How many inhalers and medicines your child has been prescribed since their last review. 5 Whether your child has a personal asthma action plan and, if so, that you know how to use it. 6 Whether your child is or has been exposed to tobacco smoke. It is recommended that spirometry is used to measure lung function, which can then be compared to best or predicted. Galant et al (2011) suggests however, although spirometry is currently considered critical to the proper diagnosis of asthma, and is emphasized for all clinicians treating patients with asthma, it can also be misleading in that many young children will have normal pre bronchodilator spirometry results regardless of the severity of their asthma. They also highlight that spirometry can be difficult for children to master so other tests should be carried out to ensure the correct values are achieved. Peak flow is a simpler test to carry out for younger children and can also be compared to best or predicted. Baseline observations such as temperature, blood pressure and oxygen saturations will be recorded and chest auscultation carried out to eliminate wheeze. If initial assessment concludes Tariq is not having an exacerbation of his asthma, continue to take a careful history to assess and identify why Tariq’s need for his reliever medication has increased.
Newcomb (2009) emphasises the importance of obtaining an environmental history and educating patients about asthma triggers are crucial for influencing asthma morbidity, and that failure to educate patients and...