07 July, 2021

Asthma in Children

Asthma in children

Asthma is a chronic inflammatory disease of airways. It is a heterogenous disease with various phenotypes which include – allergic asthma, non-allergic asthma, adult -onset asthma and asthma with obesity. 


  1. Children with asthma have repeated episodes of respiratory symptoms including
  • Cough 
  • Chest tightness
  • Noisy breathing (wheezing)
  • Shortness of breath / breathing difficulty

2. These symptoms change with time and in severity also 

3. Symptoms are more at night or in the early morning 

4. Episodes are often triggered by 

  • Viral infections
  • Seasonal change
  • Exposure to cold
  • Exercise
  • Allergen exposure
  • Irritants 

5. These episodes may start in early childhood or in older children also

6. They often have multiple such episodes with frequent hospital visits and respond to inhalation treatment

7.They may have associated allergies including eczema, allergic rhinitis or food allergy

8. There may be family history of asthma or allergy 


  • Characteristic respiratory symptoms suggestive of asthma 
  • Low forced expiratory volume in one second (FEV1) with spirometry (Lung function tests)
  • Low FEV1/FVC ratio (FVC-Forced vital capacity) with spirometry
  • Excessive variability in lung function  – Measured by bronchodilator reversibility or average diurnal variability 
  • Few children may need other test like allergic testing, CXR as per clinical condition


  • Recurrent respiratory symptoms requiring frequent hospital visit / hospitalization
  • Can develop life threatening asthma attack
  • Impaired growth 
  • Loss of school because of frequent respiratory exacerbations
  • Poor lung growth and risk for chronic lung disease because of recurrent respiratory symptoms
  • Economic burden


Prevention – Avoid triggering agents

  • Precautions during season change
  • Avoid contact with persons with acute respiratory infections
  • Avoid cold air/food
  • Avoid known allergens 

Inhaled medications

  • As the main pathology is in airways, inhaled medications are the primary treatment modality
  • Two types of medications are available – one for acute symptom relief and other for controlling ongoing inflammation of airways 
  • The choice of drugs depends on the age of the child and frequency of symptoms
  • The drugs can be taken either by nebulization or by Metered-Dose Inhaler (MDI)
  • MDI treatment is preferred in the long term as they are safe, effective and can be used outside home settings as well
  • Reliever medications
    • For acute symptom relief – Bronchodilators which increase the size of the airways and provide immediate symptom relief; Action is short lasting
    • Include salbutamol and Levosalbutamol
  • Controller medications
    • Inhaled steroids which control the ongoing inflammation of airways and decrease the frequency of asthma attacks
    • Include – Budecort, Beclomethasone, Fluticasone, Ciclesonide
  • Allergic rhinitis
  • Antihistamines – cetirizine, fexofenadine 
  • Intranasal steroids – Mometasone, budesonide and beclomethasone
  • Other medications
  • Anticholinergics – Ipratropium, tiotropium
  • Leukotriene receptor antagonist (LTRA) – Montelukast and Zafirlukast
  • Long acting beta agonists (LABA) – Salmeterol and Formoterol
  • Oral corticosteroids
  • Omalizumab and other biological agents 


  • Look for proper technique; Use of spacer in every child and mask in younger children
  • Compliance to therapy – check the number of canisters used with time, doses left in the canister
  • Identifiable triggers
  • Comorbidities – Obesity, rhinitis, rhinosinusitis and  gastroesophageal reflux
  • Review the diagnosis of asthma 


  • Every child should have a written asthma action plan
  • Identified by increased respiratory symptoms including cough, chest tightness, difficulty in breathing with viral infections or exposure to trigger
  • Give reliever medication every 6 hourly at home; Continue controller medication
  • Supportive treatment including paracetamol for fever and antihistamines for running nose
  • If improvement in symptoms, give reliever medication for 1-2 days and stop
  • If there is no improvement in symptoms in 48 -72hours or if any further worsening, visit a nearby hospital immediately and exacerbation treated as per the severity of symptoms

Most children with asthma do well with inhaled therapy if compliance is good; Only few children may need advanced therapies


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02 February, 2022

The Ultimate Guide to Taking Care of Toddlers in the Winter

With the cold weather already here, you may be thinking about whether it’s safe for your toddler to play outside or not. However, no matter if the temperatures outside are decreasing, toddlers during the winter require physical activities because they are great stress relievers for them when they are cooped up inside their house for so many hours. Thus, it is safe for a toddler to play outside during the cold weather. The American Council of Exercise even recommends that the children should receive approximately 60 minutes of physical activity each day. So you may allow your toddler for outdoor play in different intervals by providing them breaks after 10 to 20 minutes.  Here are several other tips that will facilitate outdoor play for your toddlers while keeping them safe. Dressing Them Properly During Cold Weather Toddlers during the winter should be sent outside to play only after dressing them in layers.  The layered dressing will help to keep the body warm of your toddler with scarves, boots, hats, earmuffs, socks or mittens. Additionally, the layers will not only protect your child while they’re playing outside but will also help to retain their body heat through the air pockets present in the different clothes. Though your child may become sweaty through outdoor play, you can always take off one layer. It is even recommended to dress your child in an extra layer as compared to an average adult.
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29 January, 2022

Common Diseases and Issues: Caring For a Baby And How To Prevent Them.

Caring for a baby is very crucial because during the initial first year the baby’s immune system is quite weak. Due to this, there are amplified chances for him or her to develop several common diseases in babies or sickness in infant. But with the right care, you can treat common diseases in babies easily. However, new parents and caregivers may have several questions related to their infants’ healthcare. So this guide will help you to know how to care for your baby and prevent the common diseases in babies and sickness in infant. Now let’s have a look at the common diseases in babies worth one year or less and how to care for them, or how to prevent them earlier only.  Bowel movements Keeping track of the bowel movement of your infant is crucial because this can help you to know if your infant is likely to develop any disease. So the different factors you need to consider regarding the bowel movement of your baby are as follows. Consistency. Initially, the consistency of your kid’s stool will range from loose, runny or soft. However, infant or formula-fed may have stools with a tan yellow shade and firmer as compared to the infants who are breastfed. All you need to consider while checking the consistency of your infants’ stool is that it should not be hard or very
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24 January, 2022

Baby’s First Year – Feeding Schedule and Nutrition Tips

You’ve happily clicked a snap of your little munchkin eating messily! That’s great, but now are you worried about how to provide the best nutrition to your baby in the first year? Fret not, here’s a guide on the feeding schedule for baby in the first year. Keeping in mind the fact that different infants require a different amount of nutrition, the nutrition you provide to your infant depends on his or her age, appetite, and body weight. So let’s have a glance at the healthy food for baby according to their age in the first year of birth. Newborns. As you must know, infants should receive the nutrition and calories only through breast milk or formula.  So let’s know the feeding schedule for baby with both these items. Breast milk According to the American Academy of Paediatrics, an infant should drink one to two ounces of breast milk per feeding. However, once your baby is at least two weeks old, the amount of this quantity will amplify to two to three ounces.  Generally, you need to feed breast milk to your newborn every two to three hours ass it proves to be a healthy food for baby. Formula. If you’re opting to include a formula in the feeding
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