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Paeds > Asthma in children > Flashcards

Asthma in children Flashcards

1
Q

Asthma in children Ix

A

Resp exam
basic obs
PEFR

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2
Q

Medical Mx of Asthma in children <5y

A
  1. SABA reliever
  2. consider 8 wk trial of mod dose ICS (if asthma Sx >3/wk)
  3. After 8wks stop ICS and monitor
    - not resolved: consider alt. Dx
    - Sx resolved but recurred within 4wks restart ICS at low dose
    -Sx resolved but recurred after 4wks repeat moderate dose ICS trial
  4. If asthma is uncontrolled on paediatric low dose ICS consider adding LRTA (montelukast)
    5 If still uncontrolled stop LRTA and refer to asthma expert
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3
Q

Medical Mx of Asthma in children (5-16)

A
  1. SABA reliever
  2. paediatric low dose ICS (offer first line to children w/Sx >3/wk at presentation or uncontrolled by SABA alone >3uses/wk, woken >1/wk with Sx)
  3. LTRA in addition and r/v 4-8wk
  4. stop LTRA, start LABA
  5. Change ICS+LABA to MART regimen w/low dose ICS
  6. moderate maintenance dose ICS
  7. Specialist care (paediactric high dose ICS, or additional drug e.g theophylline)
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4
Q

Non-pharm aspects of asthma Mx in children

A

Assess baseline status (asthma control questionnaire, spirometry)
Personalised asthma action plan (asthma UK)
Immunisations
signpost asthma UK
trigger avoidance (allergens, smoke, beta-blockers NSAIDS)
Anxiety and depression
Ensure pt has their own PFM
Inhaler technique

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5
Q

Other therapies in Asthma in children

A

Severe persistent unresponsive: PO pred
Omalizumab (anti-IgE)
Antihistamines and nasal steroids in allergic rhinitis

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6
Q

Complete control of Asthma in children

A

Absence of day or nighttime Sx, no limit on activities, no need for reliever use, normal lung functions and no exacerbation (need for hospital or oral steroids for 6mo)

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7
Q

Asthma in children R/V

A

Adherence
inhaler technique
r/v effectiveness of Mx
occupational asthma and triggers

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8
Q

Paediatric doses of budesonide

A

Low <200ug
mod 200-400 ug
high >400ug

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9
Q

PACES counselling of Asthma in children

A

Dx: airways sensitive and tighten suddenly making it difficult to breathe
Mx: discuss where you are on the ladder and if you need r/v
Action plan: carry blue inhaler 10 puffs every 30-60s when breathless, call 999 if no response
explain PFM
identify trigger
Asthma UK, itchywheezysneezy.co.uk

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10
Q

Acute asthma attack Ix

A

Resp exam
basic obs
PEFR

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11
Q

Moderate acute asthma attack

A

PEFR 50-75%

normal speech

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12
Q

Severe acute asthma attack

A 
PEFR: 33-50%
RR: >40 (2-5), >30(5-12), >25(>12)
HR: >140 (2-5), >125 (5-12), >110 (>12)
Unable to complete sentences in one breath
Accessory muscle use
Inability to feed
SpO2 >92
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13
Q

Life threatening acute asthma attack

A 
PEFR <33%
SpO2 <92%
Altered LOC
Exhaustion
Arrhythmia
Hypotn
cyanosis
poor resp effort
silent chest
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14
Q

admit to hospital acute asthma attack

A

anyone w/severe or LT

esp. if persists after bronchodilators

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15
Q

Mx while awaiting admission

A

1.Supplemental O2 to hypoxic pts (venturi/nc) aim for 94-94%
2. SABA:
- LT asthma: neb. ideally oxygen driven, 2.5mg if 2-5 5mg if >5 (if no nebs use MDI w/large volume spacer)
3. If SABA ineffective neb. tiotropium bromide 10mg if <2 20mg if 2-5, 30-40mg if >5
consider:
- MgSO4
- aminophylline
- IV salbutamol

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16
Q

Aminophylline consideration

A

needs to be infused slowly (or seizure, vomiting, arrhythmia)
ECG, electrolytes measured when using aminophylline and IV salbutamol

17
Q

Mx of acute asthma attack not requiring admission

A 
SABA w/large vol spacer
- 1 puff every 30-60s up to 10
- 5 tidal breaths with each puff
Oral pred 3-7d
?Abx
Once Sx subsided return to SABA prn up to 4/day (not exceeding 4hlry)
do NOT alter ICS
Monitor PEFR at home
consider starting montelukast if >2yrs
18
Q

FU of acute asthma attack

A

NOT admitted: FU within 48hrs of presentaion

Admitted: FU within 2 working days

19
Q

Patient education of acute asthma attack

A

Before d/c r/v:
1. When drugs should be used (regular/PRN)
2. inhaler technique
3. What does each drug do?
4. How much of each to use
5. What to do if things get worse
Inform parents of signs of poorly controlled asthma (cough, wheeze, dib, difficulty walking/talking, decreasing relief from bronchodilators)
Measurement of PF at home allows recognition of deteriorating asthma

20
Q

Summary of acute asthma attack

A 
Bronchodilator therapy:
beta-2 agonist via a spacer
1 puff every 30-60s up to 10
if Sx not controlled repeat beta-2 agonist and refer to hospital
Steroids:
given to all exacerbations
PO pred 3-5d:
2-5y 20mg OD
>5 30-40mg OD
21
Q

Steps in acute asthma attack Mx

A

Burst:
Salbutamol x3
ipratropium x2
PO pred x1

IV Bolus:
MgSO4
salbutamol
aminophylline

IV Infusion
aminophylline
salbutamol

panic:
intubate and ventilate

Paeds (23 decks)

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