Asthma Part 3: Special Patient Populations

Children Below 5 Years of Age

Asthma is difficult to diagnose in children below 5 years of age. As the airways of children 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 will relieve wheezing in children irrespective of whether they have asthma or not.

Your primary physician might elect to treat your child with long-term medications like inhaled corticosteroids after weighing the risks vs the benefits of the drug. They will do so especially if asthma proceeds beyond 6 years of age.

Inhaled corticosteroids are the preferred drug of choice for young children, Montelukast and Cromolyn being the other options available. Treatment is usually prescribed over a trial period between 4-6 weeks and stopped if no benefits are seen during that period of time.

Side effects of inhaled corticosteroids in very young children include slow growth across all ages. However, poorly controlled asthma also reduces a child’s growth rate. Hence, your primary physician will discuss the risks and benefits of commencing inhaled corticosteroids with you before commencing the medication.

Elderly Patients

Polypharmacy in elderly patients makes treatment in this group challenge. Commonly used drugs like Beta Blockers (for hypertension), aspirin, and other NSAIDs (for analgesia) are all contraindicated in the treatment of asthma.

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

Side effects from asthma treatment like long time consumption of corticosteroids at high doses include the development of osteoporosis and diabetes. Discuss management strategies with your primary physician before commencing these medications.

Pregnant Women

Pregnancy is complicated by asthma because the fetus requires an adequate oxygen supply above and beyond that required by the mother. Asthma also increases the risk of other complications of pregnancy, preeclampsia, pre-mature birth, and low birth weights notwithstanding.

It is more beneficial to take asthma medicines while pregnant than to risk having an asthma attack. Discuss your Asthma Action Plan with your attending physician if you’re pregnant or planning a pregnancy. 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 is a range of medications that may help prevent asthma during exercise. These include:

Short-acting Beta2-agonists – These are inhaled often before physical activity and have a duration of action up to 2-3 hours.

Long-acting Beta2-agonists – These are inhaled and have a duration of action up to 12 hours. However, tolerance to these medications can develop and with prolonged use, the duration of action of the drug will be reduced.

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

It is important to slowly ease into exercise and not to over-exert unnecessarily. A simple warm-up prior to exercise, proper clothing, and warm-down post-exercise will all aid in controlling asthma.

With proper control, asthmatics can participate in any physical activity or sport they wish.

Surgical Patients

Asthma is a significant risk factor for general anesthesia. Tracheal intubation, for example, can trigger an asthmatic attack.

Patients are advised to inform the surgeon and anesthesia team prior to surgery to pre-empt problems.

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

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