Long-term management of asthma in First Nations and Inuit children: A knowledge translation tool based on Canadian paediatric asthma guidelines, intended for use by front-line health care professionals working in isolated communities

Abstract

Asthma is a serious health problem for First Nations and Inuit children. In children younger than one year of age, asthma needs to be distinguished from viral bronchiolitis, which is unusually common in Canadian Aboriginal children. In children younger than six years of age, the diagnosis depends on the presence of typical symptoms, the absence of atypical features and the documentation of response to therapy - particularly a rapid, transient response to bronchodilators. In older children, the presence of reversible airway obstruction should be determined using spirometry whenever feasible to confirm the diagnosis. Environmental triggers should be evaluated and corrected whenever possible. Regular use of inhaled steroids is the most important measure for maintaining good asthma control in children with asthma. Clients and their families should receive asthma education. Control should be regularly reassessed at follow-up visits in health centres, with therapy adjusted to the lowest level capable of maintaining good control.

Keywords: Asthma; Bronchiolitis; Bronchodilator agents; Glucocorticoids; Indians, North American; Inuits.

Figures

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Asthma Care Map Initial Assessment.Dx Diagnosis; HCP Health care practitioner

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Asthma Care Map Follow-up Assessments Flow sheet.PEF Peak expiratory flow; S Scheduled; U Urgent

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Asthma Care Map Follow-up Assessments Flow sheet.PEF Peak expiratory flow; S Scheduled; U Urgent

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Asthma Care Map Follow-up Assessments Flow sheet.PEF Peak expiratory flow; S Scheduled; U Urgent

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Asthma Care Map Follow-up Assessments Flow sheet.PEF Peak expiratory flow; S Scheduled; U Urgent

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Asthma diagnosis and management algorithm. (Adapted from the Primary Care Asthma Program. Reproduced with permission of the Ontario Lung Association). References , , , . Adapted with permission from the Canadian Asthma Consensus Guidelines (1999), www.asthmaguide-lines.com; by the Design Task Force for the Ontario Asthma Primary Care Pilot 2002; revised by the Asthma Care Program Revision Advisory Committee 2006. CF Cystic fibrosis; CXR Chest x-ray; FEV Forced expiratory volume, GERD Gastroesophageal reflux disease