Asthma in children Flashcards
Children severe acute asthma heart rate
> 140/min in children 1-5 years
125/min in children > 5 years
Children severe acute asthma respiratory rate
> 40 in children 1-5 years
30 in children > 5 years
SpO2 severe/LT
< 92%
PEF for severe acute asthma
33-50% best/predicted
PEF for life threatening
<33
Signs of life threatening
A CHEST
Agitated/altered conscioussness
Cyanosis
Hypotension
Exhaustion
Silent chest
Threatening peak flow < 33%
what is can’t complete sentences a sign of
severe acute asthma
PEF in moderate acute asthma
> 50% best or predicted
Management acute asthma in children
- SpO2 <94% or LT : highflow oxygen via a tight-fitting face mask or nasal cannula to achieve saturations 94–98%
- Inhaled B2 agonist (salbutamol) (100 micrograms via a pMDI + spacer) 1 puff every 30-60 seconds up to a maximum of 10 puffs.
- If not controlled or LT→ hospital
- Nebulised salbutamol (2.5mg if <5 years. 5mg if >5 years)
- Nebulised ipratropium bromide (250 micrograms)
- Oral prednisolone (20 mg if aged 2–5 years and 40 mg for children >5 years )
- IV hydrocortisone (4 mg/kg repeated four hourly) if can’t oral
- Nebulised magnesium sulphate (in the first hour in children with a short duration of acute severe asthma symptoms presenting with an SpO2 <92%)
- IV salbutamol
- IV aminophylline
- IV magnesium sulphate
- Anaesthetics and ICU
GP management asthma attack
- high flow O2 if SpO2 < 94
- salbutamol via a spacer 100 micrograms - 1 puff every 30-60 seconds up to a maximum of 10 puffs.
- Oral prednisolone
- Urgent rf to hospital if uncontrolled
Dosage for spacer salbutamol @ GP
(100 micrograms via a pMDI + spacer) 1 puff every 30-60 seconds up to a maximum of 10 puffs.
Dosage nebulised salbutamol
2.5mg if <5 years
5mg if >5 years
Dosage nebulised ipatropium bromide
250 micrograms
Dosage oral prednisolone
20 mg if aged 2–5 years
40 mg for children >5 years
treatment should be given for 3-5 days
When can a child be discharged after asthma attack
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.
Investigations asthma
- spirometry with a bronchodilator reversibility (BDR) test
- a FeNO test should be requested if there is normal spirometry or obstructive spirometry with a negative bronchodilator reversibility (BDR) test
Positive spirometry result
FEV1/FVC ratio less than 70% (or below the lower limit of normal if this value is available) is considered obstructive
Positive result reversibility testing
in children, a positive test is indicated by an improvement in FEV1 of 12% or more
Positive result FeNO
in children a level of >= 35 parts per billion (ppb) is considered positive
Name the short acting asthma drugs
Beta 2 agonist: Salbutamol, terbutaline
Muscarinic antagonist: Ipratropium bromide
Name the long acting asthma drugs
Beta 2 agonist: Femeterol, salmeterol
Muscarinic antagonist: Tiotropium bromide
Management of asthma aged 5-16
- SABA
- SABA + low-dose ICS
- SABA + low-dose ICS + LTRA
- SABA + low-dose ICS + LABA
- SABA + MART (low-dose ICS + LABA)
- SABA + MART (mod-dose ICS + LABA)
- SABA + one of: high dose ICS, add drug eg theophylline, seek help)
Management of asthma aged < 5
- SABA
- 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
- SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
- Stop the LTRA and refer to an paediatric asthma specialist
normal pco2
4.7 to 6.0 kPa
what is low dose ICS
< 200mcg budesonide
If moderate asthma how do you give the salbutamol? vs severe
spacer if moderate
nebulised if sev/LT
