Yes how? I'm also curious ><
I'm going to make this as simple as possible since there are a lot of technical terms we are using. Base on
this translation, Yuzu has maintenance medication pills taken 2x a day and a probable rescue inhaler with symptoms and limitation or interference in daily activities.
Here in the Philippines and in most parts of the world, asthma is managed using what we call the Global Initiative for Asthma or GINA protocol. If you are interested you can download the protocol
here. If you do, please take a look at page 64 & 65 of the pdf file. For me the important part in management would be to assess the level of control first after doing history and physical examinations. Now using page 64 and basing on the translated article of Yuzu, I'll put him in the partly controlled category at his best level of control since the data is not enough for me to conclude. Uncontrolled if we were to consider his first season in Canada.
Now considering he is a skater I would probably start with Step 3 (low dosed inhaled corticosteroid with long acting B2 stimulant) since I often start conservatively and then observe for 1 week. But it's likely that basing on his occupation and personality I'll probably shift to step 4 (medium to high dose inhaled steroid with long acting B2 stimulant + leukotriene OR theophylline) or 5 (Step 4 + oral steroid OR anti - IgE ). This is how I will manage present Yuzu btw IF I'll get him as a patient NOW (okay, so I only have 4 months before he turns past my specialty
), although that protocol applies to above 5 years old so we never know.
Looking at the
2010 Japanese protocol (there could be an update on this but I'm not so sure), Yuzu's control is probably mild persistent to moderate persistent (page 155). Basing on page 162 he is either step 2 or 3 at the on step but again, if it was me I'll put him on step 3 due to skating then observe if I have to step up. Step 3 means low dosed inhaled steroid with or without Leukotriene receptor antagonist OR long acting B2 stimulant OR theophylline or Inhaled disodium cromoglycate (which I think is obsolete).
Now, I'm just deducing that the 2x a day pill is a sustained released theophylline or the oral form of a long acting B2 stimulant because the leukotriene receptor antagonist is taken once a day (I personally used a combined Montelukast + Levocetirizine but my pulmonologist had me shifted to inhaled steroid since I did not improved with conservative management). So Yuzu is probably step 3 or a 4 at worse BUT the translated article did not mention if he is using his inhaler for control OR rescue (in my understanding it's only rescue since he only "carries" it around). If the Japanese guideline is followed and he is on Step 3 then he should be under inhaled steroid with or without B2 stimulant or leukotriene or theophylline or DSCG with rescue meds for exacerbations or what they termed as seizure until that is controlled. Treatment steps down a lower level once that is controlled until only rescue meds are needed. Rescue med of choice is inhaled beta 2 stimulant inhalers like salbutamol since it acts fast that is why I carry them around unless I'm within reach of my nebulizer.
Maybe I'm not looking at it objectively and missed something but if he is gaining control of his asthma and I'm his pedia I'll remove the additional meds first and stick with the ICS until I can wean him off it. I'm not though and basing from my cousins medical record books as well as a junior's experienced who went to observed for a month in Nagoya, Japanese medical management is a bit different from the general consensus. She said they stick to their books although some are now reading Western books for different opinions. A bit OOT but as an example, they had a premature baby delivered about 32 wks in age and they did cranial ultrasonography and echocardiography first before they inserted an intravenous line and established temperature control. In most practice, sugar and temperature is first stabilized before we do procedures.
very interesting your info about asthma thanks ^^
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