Asthma in children

Question 1

Children severe acute asthma heart rate

Answer 1

> 140/min in children 1-5 years
125/min in children > 5 years

Question 2

Children severe acute asthma respiratory rate

Answer 2

> 40 in children 1-5 years
30 in children > 5 years

Question 3

SpO2 severe/LT

Answer 3

< 92%

Question 4

PEF for severe acute asthma

Answer 4

33-50% best/predicted

Question 5

PEF for life threatening

Answer 5

<33

Question 6

Signs of life threatening

Answer 6

A CHEST

Agitated/altered conscioussness
Cyanosis
Hypotension
Exhaustion
Silent chest
Threatening peak flow < 33%

Question 7

what is can’t complete sentences a sign of

Answer 7

severe acute asthma

Question 8

PEF in moderate acute asthma

Answer 8

> 50% best or predicted

Question 9

Management acute asthma in children

Answer 9

1. SpO2 <94% or LT : highflow oxygen via a tight-fitting face mask or nasal cannula to achieve saturations 94–98%
2. Inhaled B2 agonist (salbutamol) (100 micrograms via a pMDI + spacer) 1 puff every 30-60 seconds up to a maximum of 10 puffs.
3. If not controlled or LT→ hospital
4. Nebulised salbutamol (2.5mg if <5 years. 5mg if >5 years)
5. Nebulised ipratropium bromide (250 micrograms)
6. Oral prednisolone (20 mg if aged 2–5 years and 40 mg for children >5 years )
7. IV hydrocortisone (4 mg/kg repeated four hourly) if can’t oral
8. Nebulised magnesium sulphate (in the first hour in children with a short duration of acute severe asthma symptoms presenting with an SpO2 <92%)
9. IV salbutamol
10. IV aminophylline
11. IV magnesium sulphate
12. Anaesthetics and ICU

Question 10

GP management asthma attack

Answer 10

1. high flow O2 if SpO2 < 94
2. salbutamol via a spacer 100 micrograms - 1 puff every 30-60 seconds up to a maximum of 10 puffs.
3. Oral prednisolone
4. Urgent rf to hospital if uncontrolled

Question 11

Dosage for spacer salbutamol @ GP

Answer 11

(100 micrograms via a pMDI + spacer) 1 puff every 30-60 seconds up to a maximum of 10 puffs.

Question 12

Dosage nebulised salbutamol

Answer 12

2.5mg if <5 years

5mg if >5 years

Question 13

Dosage nebulised ipatropium bromide

Answer 13

250 micrograms

Question 14

Dosage oral prednisolone

Answer 14

20 mg if aged 2–5 years

40 mg for children >5 years

treatment should be given for 3-5 days

Question 15

When can a child be discharged after asthma attack

Answer 15

child well on 6 puffs 4 hourly of salbutamol.

They can be prescribed a reducing regime of salbutamol to continue at home, for example 6 puffs 4 hourly for 48 hours then 4 puffs 6 hourly for 48 hours then 2-4 puffs as required.

Question 16

Investigations asthma

Answer 16

1. spirometry with a bronchodilator reversibility (BDR) test
2. a FeNO test should be requested if there is normal spirometry or obstructive spirometry with a negative bronchodilator reversibility (BDR) test

Question 17

Positive spirometry result

Answer 17

FEV1/FVC ratio less than 70% (or below the lower limit of normal if this value is available) is considered obstructive

Question 18

Positive result reversibility testing

Answer 18

in children, a positive test is indicated by an improvement in FEV1 of 12% or more

Question 19

Positive result FeNO

Answer 19

in children a level of >= 35 parts per billion (ppb) is considered positive

Question 20

Name the short acting asthma drugs

Answer 20

Beta 2 agonist: Salbutamol, terbutaline

Muscarinic antagonist: Ipratropium bromide

Question 21

Name the long acting asthma drugs

Answer 21

Beta 2 agonist: Femeterol, salmeterol

Muscarinic antagonist: Tiotropium bromide

Question 22

Management of asthma aged 5-16

Answer 22

1. SABA
2. SABA + low-dose ICS
3. SABA + low-dose ICS + LTRA
4. SABA + low-dose ICS + LABA
5. SABA + MART (low-dose ICS + LABA)
6. SABA + MART (mod-dose ICS + LABA)
7. SABA + one of: high dose ICS, add drug eg theophylline, seek help)

Question 23

Management of asthma aged < 5

Answer 23

1. SABA
2. SABA + 8 weeks mod-dose ICS
   - if symptoms did not resolve during the trial period, review whether an alternative diagnosis is likely

• if symptoms resolved then reoccurred within 4 weeks of stopping ICS treatment, restart the ICS at a paediatric low dose as first-line maintenance therapy
• if symptoms resolved but reoccurred beyond 4 weeks after stopping ICS treatment, repeat the 8‑week trial of a paediatric moderate dose of ICS

3. SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
4. Stop the LTRA and refer to an paediatric asthma specialist

Question 24

normal pco2

Answer 24

4.7 to 6.0 kPa

Question 25

what is low dose ICS

Answer 25

< 200mcg budesonide

Question 26

If moderate asthma how do you give the salbutamol? vs severe

Answer 26

spacer if moderate

nebulised if sev/LT