Asthma's the most prevalent chronic disease in children and is proclaimed to be the third ranking cause of non-injury-related hospitalization among children less than 15 years of age. Asthma is a chronic inflammation or swelling of the airways and is characterized by reversible airway obstruction ---this simply means that the blockage of the airway tubes can be reversed by using medications like salbutamol which are beta2 agonists.A reversal which is more than 12% is diagnostic but can be done using a spirometer only.
During the past two decades, many scientific advances have improved our understanding of asthma and our ability to manage and control ineffectively. However, only a part of the patients reach the goals of control set out by the Global Initiative for Asthma(GINA). Management of bronchial asthma is conventionally guided by objective clinical and spirometric assessment. These criteria, though reproducible and time tested, fail to address the quality of life (QoL) of children afflicted with this chronic disease. Besides, children with similar symptoms and pulmonary function tests ( PFT) may experience different levels of distress and dysfunction in their lives.
This makes a case for a multi pronged approach to childhood asthma management that addresses qualitative issues like symptom monitoring by patients and their parents, thereby ensuring active participation in the assessment and improvement of their Quality of life of the asthmatic child.
Several studies conducted in the past have explored this idea and come up with convincing results.
Self monitoring of symptoms and keeping a record of symptoms like cough,wheezing{the whistling rhythmic sound of breathing in and out} ,sleep time cough or sleep disturbance , inability to play or getting exhausted easily,any visit to emergency room or need for inhaled medication.
Along with these measurement of peak flow expiatory rate i.e: the force with which the child expires air .Doing a peak flow monitoring at home and recording it helps to control asthma better.
study published in 2014 in Indian journal of allergy and immunology conducted at 2 centers Agra and Aligarh reflected on the scope of improvement of childhood asthma symptoms when home monitoring of symptoms was done by parents using peak flow meter and symptom diary.
Children(n =125) were divided into two age groups (6-10 years and 11-15 years)and were classified into intermittent, mild persistent, and moderate persistent grades of severity. Parental and child reporting of quality of life (QoL) scores were recorded on a pretested questionnaire on the initial visit and at 4 and 8 weeks. At each session, appropriate counseling regarding the disease and its primary management at home was done. The change in scores from first and second follow-up visits was statistically correlated with changes in symptom score recorded on symptom diary, peak expiatory flow rates(PEFR), and spirometry.
The study concluded that home monitoring of symptoms using a peak flow meter and asthma questionnaire are important tools to maximize control over asthmatic symptoms.
.Health education has a positive impact on treatment outcome. Self monitoring of symptoms at home fosters more patient involvement and promotes better management at all levels of care.
After seeing the results of this study I have shifted my asthma practice from didactic and instructional to educational and inclusive encourage every parent to maintain a symptom diary and a peak flow rate recording using a peak flow meter -it’s a cheap tool about 370 rupees and very easy to use.it shifts the focus of asthma from a disease of perception to a disease of numbers teach every parent and child and advise them to maintaining a recording as best of 3 readings in morning and evening ;and when done over a period of time it reveals lot of information regarding the child symptoms . since the last 2 years the asthmatic children have been faring better;they stick to therapy better and there are less exacerbation in symptoms and the parents feel better as they are an integral part of the therapy.
Including the parent as the monitoring angel hands the control in hands of parents and they feel more confident of the therapy.