Asthma Part 3: Special Patient Populations

Asthma Part 3: Special Patient Populations

Children under 5 years old

Asthma is difficult to diagnose in children under 5 years old. Because children's airways are naturally small, wheezing, when audible, can be confused between asthma and simple upper respiratory tract infections.

To add to the confusion, fast-acting medications like beta2 agonists relieve wheezing in children, whether they have asthma or not.

Your GP may decide to treat your child with long-term medication such as inhaled corticosteroids after weighing the risks against the benefits of the medicine. They do this especially if the asthma lasts beyond the age of 6.

Inhaled corticosteroids are the preferred drug of choice for young children, with montelukast and cromolyn being the other available options. Treatment is usually prescribed for a trial period of between 4 and 6 weeks and discontinued if no benefits are noted during this period.

Side effects of inhaled corticosteroids in very young children include slow growth across all age groups. However, poorly controlled asthma also reduces a child's growth rate. Therefore, your GP will discuss the risks and benefits of starting inhaled corticosteroids with you before you start the medication.

Elderly patients

Polypharmacy in elderly patients makes treatment difficult in this group. Commonly used medications such as beta-blockers (for high blood pressure), aspirin and other NSAIDs (for analgesia) are contraindicated in the treatment of asthma.

All elderly patients are advised to inform the doctor about all medications currently consumed.

Side effects of asthma treatment such as long-term use of corticosteroids in high doses include the development of osteoporosis and diabetes. Discuss management strategies with your primary care doctor before starting these medications.

Pregnant woman

Pregnancy is complicated by asthma because the fetus requires adequate oxygen supply beyond that required by the mother. Asthma also increases the risk of other complications such as pregnancy, preeclampsia, premature birth and low birth weight.

It is more beneficial to take asthma medication during pregnancy than risk an asthma attack. Discuss your asthma action plan with your healthcare provider if you are pregnant or planning to become pregnant. Whatever your asthma control may be, continued monitoring and control of your asthma throughout your pregnancy is essential.

Athletes and growing children

Physical activities can trigger asthma.

There are a number of medications that can help prevent asthma during exercise. These include:

• Short-acting beta2 agonists – These are often inhaled before physical activity and have a duration of action of up to 2-3 hours.

• Long-acting beta2 agonists – These are inhaled and last up to 12 hours. However, tolerance to these medications may develop, and prolonged use will shorten the drug's duration of action.

• Leukotrienes – These are often taken orally hours before physical activity and can relieve asthma symptoms.

It is important to train slowly and not to over train unnecessarily. A simple pre-exercise warm-up, appropriate clothing, and post-exercise warm-up help control asthma.

When properly controlled, asthmatics can participate in any physical activity or sport they desire.

Surgical patients

Asthma is a significant risk factor for general anesthesia. For example, tracheal intubation can trigger an asthma attack.

Patients are advised to inform the surgeon and anesthesia team before surgery to avoid problems.

In the next and final part of this series, we discuss treatment options and how asthma can be controlled.

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