Asthma in Children - passmed Flashcards
What is considered a severe asthma attack in children according to the 2016 BTS/SIGN guidelines?
- SpO2 < 92% - PEF 33-50% of best or predicted - Too breathless to talk or feed - Heart rate >125 bpm if older than 5 years, >140 bpm if between 1-5 years - Respiratory rate >30 breaths/min if older than 5 years, >40 breaths/min if between 1-5 years - Use
What are the signs of a life-threatening asthma attack in children?
- SpO2 < 92% - PEF < 33% of best or predicted - Silent chest - Poor respiratory effort - Agitation - Altered consciousness - Cyanosis
For children over 5 years old, what heart rate indicates a severe asthma attack?
Heart rate over 125 beats per minute.
For children aged 1-5 years, what heart rate is considered severe during an asthma attack?
Heart rate over 140 beats per minute.
What does PEF stand for and what are the critical PEF readings for a severe and life-threatening asthma attack in children?
PEF stands for Peak Expiratory Flow. For a severe attack, PEF is between 33-50% of the best or predicted value. For a life-threatening attack, PEF is below 33% of the best or predicted value.
What respiratory rate indicates a severe asthma attack in children older than 5 years?
A respiratory rate over 30 breaths per minute.
What respiratory rate indicates a severe asthma attack in children between 1 to 5 years old?
A respiratory rate over 40 breaths per minute.
General management strategy for children with severe or life-threatening asthma.
Children with severe or life-threatening asthma should be transferred immediately to the hospital.
Criteria for a moderate asthma attack in children aged 2-5 years.
SPO2 > 92% - No clinical features of severe asthma.
Signs of a severe asthma attack in children aged 2-5 years.
SPO2 < 92% - Too breathless to talk or feed - Heart rate > 140/min - Respiratory rate > 40/min - Use of accessory neck muscles.
Indicators of a life-threatening asthma attack in children aged 2-5 years.
SPO2 < 92% - Silent chest - Poor Respiratory effort - Agitation - Altered consciousness - Cyanosis.
Criteria for a moderate asthma attack in children older than 5 years.
- SpO2 > 92% - PEF > 50% of best or predicted - No clinical features of severe asthma.
Signs of a severe asthma attack in children older than 5 years.
- SpO2 < 92% - PEF 33-50% of best or predicted - Can’t complete sentences in one breath or too breathless to talk or feed - Heart rate > 125/min - Respiratory rate > 30/min - Use of accessory neck muscles.
Indicators of a life-threatening asthma attack in children older than 5 years.
- SpO2 < 92% - PEF < 33% of best or predicted - Silent chest - Poor respiratory effort - Altered consciousness - Cyanosis.
Bronchodilator therapy for children with mild to moderate acute asthma.
Give a beta-2 agonist via a spacer; for children < 3 years use a close-fitting mask. Administer 1 puff every 30-60 seconds up to a maximum of 10 puffs. If symptoms are not controlled, repeat beta-2 agonist and refer to hospital.
Steroid therapy recommendation for children with an asthma exacerbation.
Steroids should be given to all children with an asthma exacerbation for 3-5 days.
Usual prednisolone dose for children aged 2-5 years as per BTS and cBNF guidelines.
BTS: 20 mg once daily. cBNF: 1-2 mg/kg once daily (max 40mg).
Usual prednisolone dose for children older than 5 years as per BTS and cBNF guidelines.
BTS: 30-40 mg once daily. cBNF: 1-2 mg/kg once daily (max 40mg).
What major change did the 2017 NICE guidance introduce in the diagnosis of asthma?
The 2017 NICE guidance advocates moving away from subjective or clinical judgments toward more objective tests for diagnosing asthma.
What is the significance of fractional exhaled nitric oxide (FeNO) in diagnosing asthma?
FeNO testing is emphasized for its ability to measure levels of nitric oxide, which correlate with inflammation levels, especially from eosinophils, thus helping to diagnose asthma.
What objective tests are recommended for all patients aged 5 years and older?
Patients aged 5 years and older should undergo spirometry with a bronchodilator reversibility (BDR) test and a FeNO test.
How is asthma diagnosed in patients younger than 5 years?
In patients younger than 5 years, asthma diagnosis should be made based on clinical judgment.
What should be considered for patients 17 years and older regarding work-related asthma symptoms?
Patients 17 years and older should be asked if their symptoms improve during days away from work or holidays; if so, they should be referred to a specialist for possible occupational asthma.
What is the positive threshold for FeNO levels in adults and children?
A FeNO level of >= 40 ppb is considered positive in adults, and >= 35 ppb is considered positive in children.