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Study on asthma control status in children with bronchial asthma and allergic rhinitis - 22

No.:…………………………………. BA Code:……………………………

MEDICAL RECORD RESEARCH (re-examination)

Visit time …..

Date ……, month….., year 20…

B. Administration

Patient's full name:……………………………………Age:.......................... Date of birth:……………………………………………………………………... Gender: male □ female □

Address:……………………………………………………………………….... Mother's name: .............................................................. Phone: .....................................

B. Treatment compliance

Current medications:

Flixotide 125: …………………………………… Seretide 25/50: …………………………………… Singulair 4/ 5/ 10mg: ………………… ……………. Avamys 27.5 mcg: ………………………………… Sterimar manganese: ……………………………….. Ventolin 50mcg/puff: ……………………… ……….

Treatment compliance


Spraying properly

Yes □

No □

Quit smoking

Yes □

No □.

Forgot medication

Yes □

No □

Arbitrary increase in dose

Yes □

No □.

Reduce dose on your own

Yes □

No □.

Take medication as prescribed by your doctor Yes □ No □.

Use of antibiotics:

Yes □

No □. Drug name: ………………………

Doctor visit:

Yes □

No □. Number of times: ………..

Hospitalization due to asthma:

Yes □

No □. Time: …… days

Asthma emergency:

Yes □

No □.

Emergency resuscitation for asthma:

Yes □

No □.

Maybe you are interested!

Asthma assessment, asthma control


Characteristics: In the past 4 weeks, the patient has had

Reply

Full control

Partial control

No control

Daytime symptoms

> 2 times/week?

Yes □

No □


Do not have


There are 1- 2

characteristic


There are 3 - 4

characteristic

Any night awake

sleep due to asthma?

Yes □

No □

Need medication to reduce symptoms

evidence > 2 times/week?

Yes □

No □

Limit any activity

What is asthma?

Yes □

No □

Present: Child in asthma attack □ Out of asthma attack □

Asthma severity: Level 1 □ Level 2 □ Level 3 □ Level 4 □.

Severity of asthma:

Mild: Well controlled with first, second line treatment Yes □ No □

Moderate: Controlled with third-line treatment Yes □ No □

Severe: Requires step 4 treatment Yes □ No □

Step 5 treatment required Yes □ No □ Not controlled by step 4, 5 treatment Yes □ No □

ACT score: ……… (Questionnaire attached) CARAT score: ………. (Questionnaire attached) Assessment of risk factors for poor asthma outcomes


Risk factors for an asthma attack in the next few months

Risk factors for fixed airflow limitation

Risk factors for drug side effects

Uncontrolled asthma symptoms

 Have  1 severe exacerbation/12 months

 had NKQ placed or was in HSCC

 SABA > 200 doses/month

 Inadequate ICS: not prescribed, poor compliance, incorrect spray technique

 Low FEV1 < 60%

 Exposure: cigarette smoke, pollution, allergens

 Associated diseases: sinusitis, food allergies, obesity

obesity

 Lack of ICS treatment


 Exposure to cigarette smoke, chemicals, etc.

 Low initial FEV1


 High eosinophils in blood and sputum

System:

Oral corticosteroids: No:

High dose ICS: None: Topical:

 Gargle (or drink water) after spraying:

No Yes

 Wipe face and eyes when using ICS spray or through mask:

No Yes

Diagnosis of asthma


 During the attack

 Out of attack

 Superinfection


 No control

 Partial control

 Control H. all


 There are risk factors

 No risk factors



 Asthma level 1

 Asthma level 2

 Grade 3 asthma

 Asthma level 4


C. Clinical examination

1. General condition: Awake, good contact □ .Temperature:………..◦C Skin color:……………

Mucosal membranes: pink □, pale □ Peripheral lymph nodes: yes □, no □

Weight:…………..kg, Height:…………cm BMI:…………

Cardiovascular: Heart rate:………..beats/minute Fast □, Slow □, Normal □ Heart sounds: normal □, abnormal □ …………………

Respiration: Chest: normal, raised □, collapsed □

Respiratory rate:………….times/minute Fast □, Slow □, normal □ SpO2:…………………. RRPN: clear □, decreased□

Pulmonary rales: moist rales □, wheezing rales □, snoring rales □, bronchial rales □

Nasopharynx: Mucosa: pale □ Red □ Normal □ Nasal turbinate: edematous □ hypertrophied □ Normal □

Exudate: Clear mucus □ Cloudy mucus □ None Other parts:………………………………………………………

D. Measure respiratory function and NNO, FENO


Index

Before bronchial reversibility test

(2 puffs of ventolin through the spacer)

After test

FEV1



FVC



FEV1/FVC



PEAK FLOW



FENO nose

Bronchial FENO

F. TREATMENT

Attack relief: Ventolin: …….puffs each time, ……times a day.

Prevention: ………………………………………………….. Comorbidities: ……………………………………………. Control of triggers:………………………………. Asthma action plan………………………………….. Follow-up date ………………………………………………

Appendix 1.

ACT Asthma Control Test


ACT TEST FOR CHILDREN 4-11 YEARS OLD

Children answer the following questions themselves.

1. How is your asthma today? Score


very bad

0

Bad

1

Good

2

Very good

3


2. How does asthma make it difficult for you to run, exercise or play sports?

Asthma is

Asthma is

Asthma is

Asthma


an obstacle

an obstacle

an obstacle to

not return

big nephew

for me,

with me but

no problem

do not do

i don't

I'm fine

grandchildren

get the job done

like it

2


my idea

1


3

0




3. Do you have a cough due to asthma?


Yes, all the time

0

Yes, most of the time.

1

Yes, a little time

2

never


3


4. Does your child wake up at night because of asthma?


Yes, all the time

0

Yes, most of the time.

1

Yes, a little time

2

never


3


Parents answer the following questions:

1. During the past 4 weeks, on average, how many days per month did your child have any daytime asthma symptoms?

Row

19-24

11-18

4-11

1-3 people/month

Are not


day

ng/th

ng/th

ng/th


when


1

2


4

5

0



3



2. Over the past 4 weeks, on average, how many days per month did your child wheeze during the day?

Row

19-24

11-18

4-11

1-3 people/month

Are not


day

ng/th

ng/th

ng/th


when


1

2


4

5

0



3



3. Over the past 4 weeks, on average how many days per month did your baby wake up during the night?

Row

19-24

11-18

4-11

1-3 people/month

Are not


day

ng/th

ng/th

ng/th


when


1

2


4

5

0



3



Total ACT score: ………… ACT TEST Score FOR CHILDREN > 11 years old

Let children answer the following questions themselves.

1. In the past 4 weeks, has asthma caused you to miss work, school, or stay home? Score

All days


1

Most days


2

Some days


3

Just a few days


4

no day


5



2. In the past 4 weeks, how often have you had difficulty breathing?

More than 1 time/day


1

1 time/day


2

3-6 times/week


3

1 or 2 times/week


4

or 2 times/week


5



3. During the past 4 weeks, how often have you been woken up at night because of asthma (cough, shortness of breath, wheezing, chest pain)?

≥ 4

2-3

1 night/week

1-2

No times


night/week

night/week


times/month

any



3



1

2


4

5


4. In the past 4 weeks, how often have you had to use Ventolin or an inhaler to relieve asthma attacks?

≥ 3 times/day


1

1-2

times/day


2

2-3 times/week


3

1 time/week


4

never


5


5. How would you rate your asthma control over the past 4 weeks?

Not allowed

Control

Control 1

Control

Control


control

least

part

Good

completely

at all





1


3


5


2


4



Total ACT score: ……… points

Appendix 2. CARATkids Questionnaire


Form 1: This form is filled out by the child.

Please check the box that best describes how you have felt about your asthma/allergic rhinitis symptoms over the past 2 weeks.

Total number of Yes answers

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