Asthma in Children Flashcards
What causes asthma?
Genes 30-80% of causation
ADAM33, ORMDL3
Interaction with environment
How is asthma diagnoses?
Mainly history
Tests can exclude but not diagnose (some use of spirometry and exhaled nitric oxide)
What symptom is required for an asthma diagnosis?
Wheeze
‘No wheeze no asthma’
Cough variant asthma does not exist (in children)
What are the goals of asthma treatment?
Minimal symptoms
Minimal need for reliever medication
No attacks
No limitation of physical activity
What are the first two stages of paediatric asthma treatment?
- Very low dose ICS
(Or LTRA if under 5) - ICS plus inhaled LABA (over 5) or LTRA (under 5)
What is the third stage of paediatric asthma treatment?
If no response to LABA stop it and increase ICS to low dose.
If benefit from LABA but still inadequate control continue LABA and increase ICS to low dose, or continue LABA and ICS and trial LTRA
What is the fourth stage of paediatric asthma treatment?
Increase ICS to medium dose. Addition of SR theophylline (4th drug)
Refer patient for specialist care.
What are the adverse effects of inhaled ICS?
Height suppression
Oral candidiasis?
Adrenocortical suppression?
What non-pharmacological management can be used in asthma treatment?
Stop exposure to tobacco smoke
Remove environmental triggers
How is mild acute asthma treated?
SABA via spacer
Or SABA via spacer plus prednisolone
How is moderate acute asthma treated ?
SABA (nebulised) plus pred
Or SABA plus ipratropium plus pred
How is severe acute asthma treated?
IV salbutamol
IV aminophylline
IV magnesium
IV hydrocortisone
Intubate and ventilate
How should treatment be monitored in acute asthma?
Reassess each hour and step up down as appropriate
Be guided by oxygen saturations
