asthma Flashcards
New Asthma classifications
Intermittent (infrequent or frequent)
Persistent (Mild, moderate, severe)
What are asthma classifications based on?
frequency of symptoms
Difference between intermittent and persistent asthma?
Persistent asthma has:
- daytime symptoms 1x/ week
OR
- night time symptoms 1x/ 2 weeks
Difference between infrequent intermittent asthma and frequent intermittent asthma?
Infrequent less than every 6 weeks, frequent occurs at least every 6 weeks
Criteria for moderate persistent asthma?
Any of:
- FEV < 80
- Daily daytime symptoms
- weekly night time symptoms
Criteria for severe persistent asthma?
Any of:
- FEV <60
- constant daytime symptoms
- frequent night time symptoms
- frequent flare-ups
- activity/ sleep constantly interrupted by symptoms
Asthma Relievers
Beta 2 agonists
- sulbutamol (ventolin etc)
- turbutaline
Anticholinergics
- ipratropium bromide (atrovent) (for status asthmaticus)
Asthma Preventers
Leukotriene antagonists
- montelukast (singulair)
Mast Cell stabilisers
- Intal
ICS
- fluticasone, beclamethasone, budosenide
Asthma Symptom Controllers?
LAB2As
- salmeterol
LABA + ICS
- seretide (fluticasone + salmeterol)
- symbicort (budosenide + eformoterol)
Initial regular treatment for Infrequent Intermittent asthma?
none,
salbutamol PRN
Initial regular treatment for Frequent Intermittent asthma? (in children)
maybe montelukast (in children)
Initial regular treatment for persistent asthma?
ICS
consider trialing montelukast beforehand if only mild
What counts as good asthma control?
No night time symptoms or limitation to activities.
<2/week they have daytime symptoms/ need to use reliever
What counts as partial asthma control?
Any of:
- limitation to activities
- nightime symptoms
- daytime symptoms/ need for releiver >2 times/ week
What counts as poor asthma control?
daytime symptoms > 2 times/ week lasting for > a few minutes,
> 2 of the features of partial control
The treatment all chilren with asthma should receive?
Salbutamol PRN
If salbutamol PRN is not adequately controlling symptoms (chronically)?
A regular preventer should be used:
low dose ICS
or
montelukast
or
cromone (sodium cromoglycate)
What is the next step if a child’s asthma is not well controlled with salbutamol PRN and a regular preventer?
a stepped up regular preventer
- high dose ICS
- ICS + montelukast
- ICS/ LABA combo
What is the next step if a child’s asthma is not well controlled with salbutamol PRN and a stepped up regular preventer?
referral
What are the levels of acute asthma?
mild/ moderate
severe
life threatening
When would you consider a child with acute asthma to have mild/ moderate severity?
Can walk and speak whole sentences in one breath.
When would you consider a child with acute asthma to have severe severity?
Use of accessory muscles
Can’t complete sentences (in 1 breath)
Respiratory distress
O2 sats 90-94%
When would you consider a child with acute asthma to have life threatening severity?
Cognition affected
Exhaustion
Cyanosis
Sats <90%
Poor resp effort
Acute Athma Flare-up Protocol
Salbutamol
Systemic Steroids
Atrovent (ipratropium bromide)
+/- IV hydrocortisone, IV salbutamol, IV MgSO4, PICU, PPV
- intubate
