A 7-year-old boy is brought to your office by his mother, who reports that he has been experiencing frequent episodes of wheezing and coughing for the past 3 months. The symptoms are worse at night and often triggered by cold weather or exercise. He has had similar episodes in the past, but they have become more frequent in the last few months. His mother reports that these episodes happen around twice a week and he occasionally wakes up at night with a cough. He has not been hospitalized, but his school performance has been affected due to his symptoms. Physical Exam Findings: Respiratory rate: 22 breaths per minute Mild wheezing on auscultation, but no use of accessory muscles Oxygen saturation: 98% on room air Initial Investigations: Peak expiratory flow (PEF): 80% of the predicted value for his age and height Spirometry: Shows mild obstruction with improvement after bronchodilator use MCQs: What is the most likely diagnosis? A) Viral-induced wheezing B) Mild persistent asthma C) Allergic rhinitis D) Bronchitis What is the most appropriate long-term management plan for this child? A) Start a short-acting beta-agonist (SABA) for use only during symptoms B) Prescribe a daily low-dose inhaled corticosteroid (ICS) with as-needed SABA C) Prescribe oral corticosteroids for two weeks D) No medication, continue with lifestyle modifications What advice should be given regarding inhaler technique? A) Demonstrate the correct use of a dry-powder inhaler without a spacer B) Recommend a metered-dose inhaler (MDI) with a spacer and face mask, demonstrating the correct use C) Instruct to use the inhaler only during attacks D) Advise using the inhaler before exercise and avoid long-term use Answers with Explanations: Answer: B) Mild persistent asthma Explanation: The child has symptoms occurring more than twice a week but not daily, and he has nighttime symptoms, fitting the diagnosis of mild persistent asthma. Answer: B) Prescribe a daily low-dose inhaled corticosteroid (ICS) with as-needed SABA Explanation: For mild persistent asthma, low-dose ICS is the first-line treatment to prevent chronic inflammation, with SABA for symptom relief. Answer: B) Recommend a metered-dose inhaler (MDI) with a spacer and face mask, demonstrating the correct use Explanation: Using an MDI with a spacer ensures proper drug delivery in young children, and a face mask may be needed to improve effectiveness. Overview of the Topic: Mild Persistent Asthma Mild persistent asthma involves symptoms occurring more than twice a week but less than daily. Long-term management includes daily low-dose inhaled corticosteroids and as-needed short-acting bronchodilators. Proper inhaler technique is critical, especially in children. Key Learning Points: Asthma severity should be assessed based on frequency of symptoms and exacerbations. Inhaled corticosteroids are first-line treatment for persistent asthma. Ensure caregivers understand proper inhaler technique and spacer use.
