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Bronchial asthma in children


Asthma is a chronic inflammatory condition with reversible airways obstruction. Symptoms usually start after 2 years of age but may present earlier. The  Common triggers are environmental allergen, colds and exercise. The management of Asthma involves using drugs to control of inflammation of the lung, avoiding triggers as possible and using medications to treat asthma attacks.

Signs and symptoms include;

  • Frequent coughing worsening with viral infection, or with sleep and exercise or cold air

  • Wheezing sound when breathing out

  • Shortness of breath

  • Rapid breathing

  • Chest tightness

  • Labored breathing

  • Bouts of coughing or wheezing that get worse with a cold or the flu

  • Delayed recovery or bronchitis after a respiratory infection

  • Reduced play or exercise due to difficult in breathing

  • Fatigue due to poor sleep

Risk factors for developing asthma are

  • Family history of allergies and/or asthma

  • Frequent respiratory infections

  • Environmental Allergies such as air pollution, dust and dandruff

  • Being born premature or  with low birth weight

  • Second-hand smoke before and/or after birth

  • Growing up in a low income, urban environment

Diagnostic criteria

  • Paroxysmal respiratory distress

  • Recurrent cough

  • Wheeze

  • Chest tightness

  • FEV1 of less than 80%

  • Good response to treatment with a bronchodilator



  • FPB

  • Arterial Blood gases (ABG) Analysis

  • Chest X- ray: Is often normal, therefore not routinely required

  • Spirometry


Non pharmacological

  • Give Oxygen 2-4L/min

Pharmacological treatment

For Severe Asthma

Admit to hospital:

  • Give nebulized salbutamol 5mg (i.e. 0.5 ml of the 5 mg/ml  nebulizer solution) PLUS Budesonide 0.25mg once daily

  • Repeat intermittently 4-6 hourly until the child is stable.

  • Step down to metered dose inhalation(MDI) for stable childreno

  • Introduce two puffs (200μg) into the spacer chamber 6-8 hourly  for 2-4 weeks AND Budesonide MDI: 100,200 mcg/dose (puff), starting dose 100μg to 200μg 12 hourly.

  • For Persistent Asthma Salmeterol 50μg 12 hourly and Fluticasone MDI: 50,125,250mcg/puff, stating dose 50 to 250μg 12 hourly can be used


  • Mild Asthma use Salbutamol MDI 400μg as needed.

  • Intermittent Asthma use Salbutamol/Budesonide 12 hourly

  • Chronic Persistent Asthma use Salmeterol/Fluticasone 12 hourly

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Last updated on 24.08.2020


  1. American academy of astha allegy and immunology. Pediatric asthma. August 24.02.2020

  2. Mayo clinic. Asthma in children. August 23.02.2020 

  3. Tanzania standard treatment guideline edition 2017. page 63-64

  4. Mayo clinic. Bronchial asthma August 24.2020

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