Asthma

Question 1

What are the diagnostic criteria for asthma in children age 1-5 years?

Answer 1

1. Documentation of airflow obstruction
   - Includes wheezing + signs of airflow obstruction observed by HCP
2. Documentation of reversibility of airflow obstruction
   - Improvement with SABA +/- oral corticosteroids by HCP
   - Convincing parental report of symptomatic response to 3 month trial of medium dose ICS
3. No evidence of alternate diagnosis

Question 2

As per CPS, the diagnosis of asthma should be considered in children one to five years of age with:

Answer 2

1. Frequent (>8 days/month) asthma-like symptoms
2. Recurrent (>2 exacerbations - episodes with asthma-like signs)

Question 3

As per CPS, children 1-5 years of age with recurrent (>2) episodes of asthma-like symptoms, no wheezing on presentation, frequent symptoms or any mod-severe asthma exacerbation warrant ….

Answer 3

Three month trial with a medium dose daily ICS, with as-needed SABA

Question 4

As per CPS, children 1-5 years of age with recurrent (>2) episodes of asthma-like symptoms, no wheezing on presentation, infrequent symptoms and mild asthma exacerbation warrant ….

Answer 4

Ongoing monitoring & re-assessment when symptomatic
Alternatively, may consider a trial of PRN SABA

Question 5

As per the CPS Asthma Statement, what are reasons to refer to an asthma specialist?

Answer 5

Diagnostic uncertainty or suspicion of co-morbidity

Repeated (>2) asthma exacerbations requiring rescue oral corticosteroids or hospitalization and frequent symptoms (>8 days/month) despite moderate (200-250 ug) daily doses of ICS

Life threatening event such as admission to ICU

Need for allergy testing to assess possible role of environmental allergens

Other considerations (parental anxiety, need for reassurance, additional education etc.)