Neftaly Pediatric Asthma Management Protocols

1. Introduction

Asthma is one of the most common chronic conditions affecting children globally. Neftaly is committed to improving pediatric asthma outcomes through evidence-based, standardized, and culturally appropriate protocols that ensure early detection, appropriate treatment, and effective long-term management.

These protocols are aligned with international guidelines such as GINA (Global Initiative for Asthma) and adapted for community-level implementation across diverse healthcare settings.

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2. Goals of the Protocol

• Improve early identification and diagnosis of pediatric asthma
• Standardize treatment approaches based on severity and risk
• Enhance caregiver and patient education
• Promote adherence to controller medication and follow-up
• Reduce emergency visits and hospitalizations
• Enable safe and effective asthma care in both home and clinical settings

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3. Definitions and Classifications

3.1 Definition of Asthma

A chronic inflammatory disease of the airways characterized by recurring symptoms, reversible airflow obstruction, and bronchospasm.

3.2 Asthma Severity Categories

Severity	Symptoms	Nighttime Awakenings	SABA Use	Activity Limitation	Lung Function
Intermittent	≤2 days/week	≤2x/month	≤2 days/week	None	Normal FEV1
Mild Persistent	>2 days/week	3–4x/month	>2 days/week	Minor limitation	FEV1 ≥80%
Moderate Persistent	Daily	>1x/week	Daily	Some limitation	FEV1 60–80%
Severe Persistent	Throughout day	Frequent	Several times/day	Extreme limitation	FEV1 <60%

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4. Diagnosis and Initial Assessment

• History: Recurrent wheezing, coughing, chest tightness, or shortness of breath, especially at night or with activity
• Physical Exam: Wheezing, prolonged expiration, accessory muscle use
• Risk Factors: Family history, allergies, environmental triggers (smoke, dust, pets)
• Diagnostic Tools:
  • Peak Expiratory Flow (PEF)
  • Spirometry (children >5 years)
  • Response to bronchodilators

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5. Treatment Protocols

5.1 Acute Asthma Exacerbation Management

Severity	Treatment
Mild	Inhaled SABA (e.g., Salbutamol) 2–4 puffs every 20 min for up to 1 hour. Monitor.
Moderate	SABA + Oral corticosteroids (Prednisolone 1–2 mg/kg/day, max 40 mg). Observe for response.
Severe	SABA + Ipratropium bromide + Oral/IV corticosteroids + O2 if saturation < 92%. Urgent referral if no response.
Life-threatening	Emergency referral. Nebulized SABA every 20 min, high-flow oxygen, corticosteroids, and possible magnesium sulfate IV.

5.2 Long-Term Management (Stepwise Approach)

Step 1: Intermittent Asthma

• SABA as needed

Step 2: Mild Persistent Asthma

• Low-dose ICS + SABA as needed

Step 3: Moderate Persistent Asthma

• Low-dose ICS + LABA
  OR
• Medium-dose ICS

Step 4: Severe Persistent Asthma

• Medium/high-dose ICS + LABA
• Consider leukotriene receptor antagonist (LTRA)

Step 5:

• Referral to specialist
• Consider biologics or additional systemic therapy

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6. Asthma Action Plan

Each child should have a written Asthma Action Plan, tailored to their severity and triggers. The plan includes:

• Daily management: medications and dosages
• Green Zone: Stable – continue controller
• Yellow Zone: Warning signs – increase reliever use, consider oral steroids
• Red Zone: Emergency – seek immediate medical attention

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7. Education and Caregiver Support

Educate families and caregivers on:

• Inhaler technique (use of spacers)
• Trigger identification and avoidance
• Importance of medication adherence
• Recognizing early signs of exacerbation
• When to seek emergency care

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8. Follow-Up and Monitoring

• Routine check-ups every 1–3 months for moderate to severe cases
• Review control, inhaler technique, and adherence
• Update asthma action plan as needed
• Monitor growth and side effects from corticosteroids

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9. Special Considerations

• School-based asthma care: Coordinate with teachers and school nurses
• Comorbidities: Allergic rhinitis, eczema, obesity
• Psychosocial impact: Address anxiety or stigma associated with chronic illness

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10. Documentation and Reporting

Healthcare providers should:

• Record all visits, medication changes, and exacerbations
• Use standardized forms for asthma management
• Report severe exacerbations or hospitalizations to Neftaly central registry for tracking outcomes

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11. Training and Implementation

Neftaly offers structured training for:

• Community Health Workers
• Nurses and Clinic Staff
• School Health Coordinators

Training includes:

• Clinical management
• Communication strategies
• Emergency protocols
• Simulation-based practice

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12. Review and Updates

These protocols are reviewed annually to ensure alignment with the latest clinical guidelines and local health policies. Feedback from frontline workers and caregivers is integrated into each revision.

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For questions, feedback, or support on implementation, please contact the Neftaly Health Programs Office.