Pediatric Asthma: Diagnosis, Management, and Cultural Care

Introduction to Pediatric Asthma

Asthma is a chronic inflammatory disorder that affects the airways and is usually characterized by breathlessness or difficulty in breathing, occurring in both adults and children. Among adolescents between the ages of 5 and 17, asthma is responsible for the loss of over 10 million school days per year and consumes approximately $726.1 million of caregivers' money annually due to absence from work (Jackson, Lemanske & Guilbert, 2014). Worldwide, asthma is the most prevalent severe lower respiratory ailment in children. Most often, asthma begins early in life and follows different courses with highly unstable phenotypes that may remit or progress over time.

In preschool children, wheezing may result from a variety of conditions. Regardless of treatment, more than half of preschool wheezers become symptomatic by the time they reach school age. However, asthma symptoms may persist for a long time — sometimes for the duration of the patient's life — most commonly in atopic cases and other more severe presentations. The effects of asthma on patients' quality of life, as well as the cost of treatment, are considerable. Adequate management can therefore have a significant impact on the patient's quality of life and the well-being of their immediate families, as well as on public health outcomes.

Purpose and Care Framework

Asthma is a respiratory disorder caused by as-yet unspecified triggers, making it difficult to treat and at times even difficult to diagnose. The only way to counter an asthma attack is to control it effectively when it occurs and then follow it up rigorously through sustained monitoring. In the absence of clear clinical direction, cultural and ethnic considerations in the treatment of asthma cannot be ignored.

Diagnosis of Asthma in Children

The aim, therefore, is to formulate a clear line of action and a framework to diagnose, treat, and monitor asthmatic patients. Such a framework should help prevent, alleviate, and control pain and discomfort, as well as the occurrence of extreme conditions. The nursing community would need to be culturally sensitive, as ethnic and traditional practices appear to provide solace to patients inclined toward such belief systems.

A history of repeated wheezing episodes is accepted worldwide as the starting point for diagnosis in children. The required number of these episodes is not generally specified, though a figure of two or three has been suggested. Establishing the diagnosis requires the presence of specific symptoms, including repeated wheezing, cough, difficulty breathing, and tightness in the chest. These symptoms are typically caused by excessive exposure to various stimuli such as irritants (tobacco smoke, cold air), allergens (pollen, pets), exercise, respiratory infections, laughter, or crying, and they most often appear in the early morning or at night (Lugogo, Que, Gilstrap & Kraft, 2015).

A personal history of atopy-related conditions — such as allergic rhinitis, eczema, or food and aeroallergen sensitization — and a family history of asthma both contribute to a more effective diagnosis. Because these symptoms are not pathognomonic and may arise from a number of different conditions, differential diagnosis is essential. This process involves ruling out common childhood problems as well as a range of severe but infrequent diseases, all of which appear across clinical guidelines with minor variations.