Asthma in Preschoolers Flashcards
What is the pathophysiology of asthma?
- Inflammation, increased mucus production
- Bronchoconstriction
- Reversible airflow obstruction
What are some common asthma symptoms?
- Coughing
- Wheezing
- Chest tightness
- Shortness of breath
- During physical activity or at night
What are some common asthma triggers?
- Allergens, respiratory infections, exercise, and environmental irritants
How are children under 6 diagnosed with asthma?
Unlike older children and adults, children under 6 cannot take spirometry tests reliably. Younger patients are diagnosed based on presence of symptoms suggestive of asthma
What is the impact of asthma in preschool-aged children?
Increased emergency department visit and hospital admissions
Airway remodelling leading to altered lung function trajectory into adulthood
What are some signs of airflow obstruction?
- Wheezing is the most specific sign
- Other breath sounds may be heard (decreased to the bases), needs to be assessed by HCP trained in auscultation
- Tachypnea, prolonged expiration, accessory muscle, hypoxemia, altered level of consciousness
- Cough (non-specific), chronic cough that occurs while sleep or triggered by allergens, exertion, laughing, or crying
What medications are used ot treat asthma symptoms in patients under 6?
- Inhaled corticosteroids (ICS)
- SABA
- Oral steroids (usually dexamethasone)
What is the role of inhaled corticosteroids in treating asthma in patients under 6?
Reduce airway inflammation and prevent asthma symptoms (controller)
Beclomethasone is preferred by Saskatoon pediatricians, but fluticasone and budesonide are also fine
What is the role of SABAs in treatment of asthma in patients under 6?
Rapidly relax and open the airways, providing quick relief of symptoms (onset of action is 10 minutes)
Salbutamol is the most widely used SABA
Watch for overuse (more than 2 refills per year = uncontrolled asthma)
What do asthma treatment trials look for young children who showed signs of airway obstruction during prescriber visit?
Start on SABA +/- oral corticosteroid (depending on severity of airway obstruction)
Assess patient response at appropriate intervals (during refills).
Check adherance and provide plan for caregivers
What do therapeutic trials look like for young children who do not show signs of airway obstruction during prescriber visit?
Start on the following depending on severity of symptoms:
- PRN SABA x 3 months and reassess
- Medium dose ICS, and PRN SABA x 3 months, then reassess
Reassess in three months (dechallenge can be initiated)
What is the role of pharmacists in treatment of asthma in patients under 6?
Give context about what patients can expect when starting therapy at a young age
Ensure patient is using the medication appropriately
Efficacy is important to assess, figure out if this will be a long-term medication
What are some characteristics of successful asthma therapeutic trial in children under 6?
Adherence
Adequate inhalation technique
Diligent documentation of signs/symptoms (completed by caregiver, and brought to prescriber)
Timely medical reassessment
What factors should be considered when reassessing a new Rx for an inhaler for young children (under 6)?
Confirm patient’s asthma symptom history (should ideally be tracked by caregiver over the trial duration)
- Airway obstruction
- Symptom frequency
Confirm therapeutic trial plan
- Make sure caregivers understand what they need to do in the next three months
- Manage their expectations
What is the most concerning adverse events that caregivers associate with inhaled corticosteroid use in young children?
Growth and Adrenal Suppression
Minimal risk overall, and all options are fine to use. Newer ICS may have lower bioavailability = potentially lower ADR risk
