Asthma is characterised by chronic inflammation, variable airflow limitation, and airway reversibility. Masekela et al caution that worldwide, asthma is the most chronic non-communicable disease in children. “The burden of asthma in children is increasing in low- and middle-income countries and remains under-recognised and poorly managed”.¹ 

CAUSES AND TRIGGERS 

Asthma's exact cause remains elusive, though diverse factors contribute to its development, particularly in children. Genetic predisposition, prenatal and early childhood allergen exposure, maternal infections, smoking during pregnancy, environmental tobacco smoke, viral respiratory illnesses, obesity, diet, hygiene, and toxic exposures are implicated.² When triggered, the body releases histamine and other agents, inflaming airways, causing muscle contraction, and increasing mucus production.³ 

SYMPTOMS AND DIAGNOSIS 

Childhood asthma symptoms, often appearing before age five, include chest tightness, shortness of breath, wheezing, and nighttime coughing. Recognising these signs can be challenging in very young children, as similar symptoms could stem from other conditions.⁴ Asthma attacks are frequently triggered by colds, with children being more susceptible than adults.⁵ Diagnosis is more straightforward in school-aged children compared to preschoolers.⁶ Stanford’s Children’s Health recommends tests like spirometry, peak flow monitoring, chest X-rays, and allergy tests.⁷ 

TREATMENT 

Pharmacotherapy aims to control symptoms and prevent exacerbations while minimising side effects. Treatment progression hinges on symptom persistence, severity, and frequency, along with the asthma phenotype.⁸(10). Long-term control medications encompass inhaled corticosteroids, leukotriene modifiers, combination inhalers, theophylline, and immunomodulatory agents.9 Short-term relief medication, carried at all times, swiftly addresses coughing, wheezing, and shortness of breath during an asthma attack.⁴ 

Long-Term Control Medications: 

• Inhaled Corticosteroids (ICS): These medications, including fluticasone, budesonide, mometasone, ciclesonide, and beclomethasone, hold a pivotal role in managing the persistent inflammation that characterises asthma. The gradual reduction of inflammation in the airways is crucial for maintaining long-term asthma control. It is worth noting that the full therapeutic effects of ICS may take several days to weeks to manifest.⁹ 
• Leukotriene Modifiers: These oral medications, exemplified by montelukast, zafirlukast, and zileuton, function by intervening in the inflammatory pathway and are particularly suitable for patients with allergic asthma. By targeting specific mediators of inflammation, these medications contribute to preventing asthma symptoms for a period of up to 24 hours.⁹ 
• Combination Inhalers: Incorporating both an inhaled corticosteroid and a long-acting beta-agonist (LABA), combination inhalers like fluticasone/salmeterol and budesonide/formoterol offer a multifaceted approach to asthma management. Mayo Clinic cautions that because in some situations LABA have been linked to severe asthma attacks, LABA medicines should always be given to a child with an inhaler that also contains a corticosteroid. These combination inhalers are a strategic option for cases where alternative medications fail to yield adequate asthma control.⁹ 

Short-Term/Quick Relief Medications: 

Vital for prompt alleviation of acute symptoms and asthma attacks, short-term or quick relief medications provide swift relief from coughing, wheezing, and shortness of breath. Typically delivered via inhalers, these medications should be readily accessible to patients and administered as soon as symptoms emerge. 

REFERENCES: 

1. Masekela, R et al. (2018). ‘The Increasing Burden of Asthma in South African Children: A Call to Action.’ Available from: https://www.researchgate.net/publication/326235989_The_increasing_burden_of_asthma_in_South_African_children_A_call_to_action 
2. Noutsiosa , G.T & Floros, J. (2014). ‘Childhood Asthma: Causes, Risks, and Protective Factors; a Role of Innate Immunity.’ Available from: https://www.researchgate.net/publication/270003259_Childhood_asthma_causes_risks_and_protective_factors_a_role_of_innate_immunity 
3. Children’s Health. ‘Pediatric Asthma.’ Available from: https://childrensnational.org/visit/conditions-and-treatments/airway-lungs/asthma 
4. American College of Allergy, Asthma and Immunology. ‘Asthma in Children.’ Available from: https://acaai.org/asthma/asthma-101/asthma-in-children 
5. Asthma Canada. ‘Asthma in Infants and Young Children.’ Available from: https://asthma.ca/get-help/asthma-3/control/infants-and-children/ 
6. Van Aalderen, W.M. (2012). ‘Childhood Asthma: Diagnosis and Treatment.’ Available from: https://www.researchgate.net/publication/258924299_Childhood_Asthma_Diagnosis_and_Treatment 
7. Stanford’s Children. ‘Asthma in Children.’ Available from: https://www.stanfordchildrens.org/en/topic/default?id=all-about-asthma-in-children-90-P01664 
8. Bacharie, L.B. et al. (2008). ‘Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report.’ Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1398-9995.2007.01586.x 
9. MayoClinic. ‘Childhood Asthma.’ Available from: https://www.mayoclinic.org/diseases-conditions/childhood-asthma/diagnosis-treatment/drc-20351513