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systems: resp. wk > 30. Asthma Management in Children > Flashcards

30. Asthma Management in Children Flashcards

1
Q

Is there a cure for asthma?

A

No cure, only palliation or spontaneous resolution

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2
Q

What are the main goals of asthma treatment? (5)

A
  • minimal symptoms during day and night
  • minimal need for reliever medication
  • no exacerbations/ worsening
  • no limitation of physical activity
  • normal lung function (FEV1>80% predicted or best)
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3
Q

How to measure control of child’s asthma? In terms of what to look at (SANE)

A 
Short acting beta agonist/week 
Absence of school/nursery 
Nocturnal symptoms/week 
Excertional symptoms/ week 
(SANE)
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4
Q

What are classes of medications used to treat child asthma? (6)

A
  1. short acting beta agonists
  2. inhaled corticosteroids
  3. long acting beta agonists (add ons)
  4. leukotriene receptor antagonist (add ons)
  5. theophyllines (add ons)
  6. oral steroids
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5
Q

Do inhaled corticosteroid doses overlap with adult doses?

A

Yes; very low, low, medium and high

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6
Q

What should the ICS dose be at the start of asthma treatment? How long after the treatment start should the review be done?

A

low dose; and review after 2 months

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7
Q

What is the criteria for medication administration for child asthma?

A
  • Max dose ICS 800microgram
  • NO oral B2 tablet
  • LTRA first line preventer in <5s (leukotriene receptor antagonist)
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8
Q

What is the Step 1 in treating asthma in children?

A
  • SABA (short acting beta agonist)
  • inhaled (not oral)
  • spacer/ MDI (meter dosed inhaler) or dry powder inhaler
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9
Q

What is the step 2 in treating child asthma?

A

-REGULAR PREVENTER ( very low dose of inhaled corticosteroids or LTRA in <5s)
; leukotriene receptor antagonist

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10
Q

When should a regular preventer be used? (step 2) (3)

A
  1. if using an inhaled B2 agonist 3x a week or more
  2. if symptomatic 3x a week or more or waking one night a week
  3. if exacerbations of asthma in the last 2 years
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11
Q

What is the step 3 in treating child asthma?

A

Add on a preventer (where it becomes more complicated)

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12
Q

What are preventers used to for step 3 of treating child asthma? (3)

A
  1. add on LABA
  2. add on LTRA
  3. increase ICS dose
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13
Q

What is the stance for high dose therapies in under 5 year olds?

A

Refer for confirmation of diagnosis

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14
Q

What is the stance for high dose therapies in over 5 year olds?

A

Increase to medium dose ICS and consider referral

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15
Q

What is always needed before putting a child patient on continuous or regular oral steroids?

A

always refer!

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16
Q

What are main advantages of using inhaled corticosteroids?

A
  1. very useful for diagnosis
  2. very effective
  3. very safe (when prescribed correctly)
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17
Q

What is the safe dose range for inhaled corticosteroids?

A

200-800

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18
Q

What are some adverse effects of ICS; inhaled corticosteroids? (3)

A
  1. height suppression
  2. oral candidiasis (thrush)
  3. adrenocortical suppression
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19
Q

Which ICS particularly gives bad adverse effects?

A

fluticasone

20
Q

What are 2 important things to remember when using long acting beta agonists?

A
  1. do not use without ICS

2. use as fixed dose inhaler

21
Q

What is the step 4 of treating child asthma?

A

Long acting beta agonist

22
Q

What is the step 5 of treating child asthma?

A

Leukotriene receptor antagonist

23
Q

What is the leukotriene receptor antagonist used in children? (its name)

A

Montelukast

24
Q

In what form does the leukotriene receptor antagonist (LRA), Montelukast appear in for reluctant toddlers?

A

In granules

25
Q

What is the step 6 of treating child asthma?

A

Experimental medicine (only needed for minority with genuine severe disease)

26
Q

When is experimental medicine used? (i.e. what sort of lung issues are needed)

A
  1. 50% physiological

2. > 50% compliance issues

27
Q

What are two types of delivery methods of treatment for asthma in children?

A
  1. MDI/+spacer

2. dry powder device

28
Q

What are the 3 rules for using a spacer?

A
  1. shake inhaler between puffs
  2. wash spacer monthly to reduce static
  3. each increases delivery by 100%
29
Q

What is the lung deposition without a spacer?

A

<5%

30
Q

What is the lung deposition with a spacer?

A

<20% (better lung deposition)

31
Q

What are some of the factors which affect lung deposition? (3)

A
  1. with a not tightly fitting face mask
  2. crying during inhalation
  3. quietly inhaling
32
Q

What age groups use the dry powder devices?

A

licensed in over 5s (under 8s cannot use them)

33
Q

What is the lung deposition in dry powder devices?

A

20%

34
Q

Why are MDI spacers more reliable than nebulisers? (6)

A
  1. quieter
  2. quicker
  3. valve mechanism
  4. don’t break down
  5. portable
  6. cheaper
35
Q

When are nebulisers used in asthmatic patients?

A
  • when high doses of asthma reliever medicines are needed in an emergency
  • turns medication into mist and is easier to deliver as it has a mouthpiece and a facemask
  • not used day-day
36
Q

What are other management techniques for child asthma? (2)

A
  1. stop tobacco smoke exposure

2. remove environmental triggers (e.g. cats or house dust mites)

37
Q

What are the 2 initial steps for treating acute MILD asthma? (starters)

A
  1. SABA via spacer

2. SABA via spacer +prednisolone

38
Q

What are the 2 next steps for treating acute MODERATE asthma? (main course)

A
  1. SABA via nebuliser +prednisolone

2. SABA +ipratropium via nebuliser +prednisolone

39
Q

What are the 5 steps for treating acute SEVERE asthma? (specials)

A
  1. IV salbutamol
  2. IV aminophylline
  3. IV magnesium (nebuliser)
  4. IV hydrocortisone
  5. Intubate and ventilate
40
Q

What are the factors that need to be taken into account for deciding how to treat acute asthma? (7)

A
  1. respiratory rate
  2. work of breathing
  3. heart rate
  4. oxygen saturations
  5. ability to complete sentences
  6. confusion
  7. air entry
41
Q

After treating acute asthma (either mild, moderate or severe), how long should you wait for before reassessing?

A

1 hour

42
Q

What type of steroids are used for chronic/maintenance treatment of asthma?

A

inhaled steroids

43
Q

What type of steroids are used for acute treatment of asthma?

A

oral steroids

44
Q

What are MDIs useless without?

A

spacer

45
Q

There is a different approach to treating asthma in children of what age?

A

under and over 5s

systems: resp. wk (40 decks)

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