Acute asthma: Children Flashcards
The severity of an asthma exacerbation is graded as moderate, severe, and life-threatening in children over 2. Outline the criteria for moderate severity acute asthma in children (5)
1) Peak flow ≥ 50% best or predicted
2) SpO2 ≥ 92%
3) Heart rate ≤ 140/minute in 2-5 years
↳ ≤ 125/minute in children over 5 years
4) Respiratory rate ≤ 40/minute in 2-5 years
↳ ≤ 30/minute in children over 5 years
5) Able to talk in sentences
Outline the criteria for severe acute asthma in children (4)
1) Peak flow 33–50% best or predicted
2) SpO2 < 92%
2) Heart rate > 140/minute in children aged 2-5
↳ > 125/minute in over 5 years
3) Respiratory rate > 40/minute in 2–5 years
↳ > 30/minute in children aged over 5
4) Can’t complete sentences in one breath or too breathless to talk or feed
Outline the criteria for life-threatening acute asthma in children (8)
Any one of the following in a child with severe asthma:
1) Peak flow < 33% best or predicted
2) SpO2 < 92%
3) Silent chest
4) Cyanosis
5) Poor respiratory effort
6) Hypotension
7) Exhaustion
8) Confusion
When should children be given high flow oxygen and what oxygen saturation would need be achieved?
1) all children with life-threatening acute asthma or SpO2 < 94%
2) to achieve normal saturations of 94-98%
1) What is the First-line treatment for acute asthma in children?
2) When should children be treated in secondary care?
1) B2- agonist - salbutamol or terbutaline - ASAP via a metered dose inhaler and spacer device in mild to moderate acute asthma
2) Those with severe or life-threatening acute asthma should be transferred to hospital urgently
In all cases of acute asthma, children should be prescribed oral steroids. Which steroid is chosen and how many days is this prescribed for?
Prednisolone- length tailored to the number of days necessary to bring about recovery. But normally 3 days
1) Child 6 to 12 years: 30–40 mg OD for 3 days
2) Child 2 to 5 years: 20 mg OD for 3 days
3) Child under 2 years: 10 mg OD for 3 days
Which alternative steroid could be prescribed to children who are unable to take oral prednisolone?
IV hydrocortisone reserved for severely affected children who are unable to retain oral medication.
When would Nebulised ipratropium bromide be considered for children with acute asthma?
Nebulised ipratropium bromide combined with b2-agonist in severe or life-threatening acute asthma or in those with a poor initial response to b2- agonist therapy
1) When would magnesium sulphate be considered for children with acute asthma?
2) What should this be given with?
1) In the first hour in children with a short duration of acute severe asthma symptoms presenting with an oxygen saturation less than 92%
2) Magnesium sulphate would be added to nebulised salbutamol and ipratropium bromide
When should children be moved to the paediatric intensive care unit (PICU) to receive second-line intravenous therapies?
continuing severe asthma despite nebulised b2-agonist and ipratropium bromide + oral corticosteroids, and those with life-threatening features
In a severe asthma attack where the child has not responded to initial inhaled therapy what should be considered?
1) a single bolus dose of intravenous salbutamol
2) Consider continuous intravenous infusion of salbutamol, under specialist with continuous ECG and electrolyte monitoring, in children with unreliable inhalation or severe refractory asthma.
1) When would Aminophylline be considered in children with acute asthma?
2) Which level of severity is aminophylline not recommended in?
1) severe or life-threatening acute asthma unresponsive to maximal doses of bronchodilators and corticosteroids
2) not recommended in children with mild to moderate acute asthma
In general how are children under 2 years presenting with an acute asthma attack managed?
1) inhaled SABA - For mild to moderate acute asthma attacks, a metered-dose inhaler with a spacer and mask is the optimal drug delivery device.
2) In a hospital setting, consider oral prednisolone daily for up to 3 days, early in the management of severe asthma attacks.
3) For more severe symptoms, inhaled ipratropium bromide in combination with an inhaled b2-agonist is also an option
Outline the follow up measures that need to be conducted in all cases for those who have experienced an asthma attack (6)
1) Review preventative therapy
2) History should be taken to establish the reason for the asthma attack
3) Inhaler technique should be checked
4) Patients should be given a written asthma action plan
5) GP practice informed within 24 hours of discharge
6) Respiratory specialist should follow up all patients admitted with a severe asthma attack for at least one year after the admission
How long should patients who have had a near-fatal asthma attack be kept under specialist supervision?
Indefinitely
