Asthma In Preschoolers

Question 1

What is the #1 most common condition in kids?

Answer 1

asthma
-850k + affected

Question 2

What are examples of the consequences of uncontrolled asthma in kids?

Answer 2

school absenteeism
-may disrupt education and social development
hospitalization
-heavy burden on families and the healthcare system

Question 3

What is the pathophysiology of asthma?

Answer 3

inflammation, increased mucus production
bronchoconstriction
reversible airflow obstruction

Question 4

What are the symptoms of asthma?

Answer 4

coughing
wheezing
chest tightness
SOB
during physical activity or at night

Question 5

What are some examples of potential asthma triggers?

Answer 5

allergens
respiratory infections
exercise
environmental irritants

Question 6

Why is it hard to diagnose asthma in preschoolers?

Answer 6

diagnosis of asthma relies on spirometry
-preschool aged children (<6yrs) are not able to reliably complete pulmonary function tests
preschoolers with symptoms suggestive of asthma are challenging to diagnose

Question 7

How does asthma generally manifest itself in preschoolers?

Answer 7

as wheeze
-associated with decreased lung function
-increased emergency department visits and hospital admissions

Question 8

What is the worst outcome of asthma in terms of lung function?

Answer 8

airway remodelling leading to altered lung function into adulthood

Question 9

What is the most specific sign of airflow obstruction?

Answer 9

wheezing
-other breath sounds may be heard
-maybe tachypnea, hypoxemia, use of accessory muscles, altered level of consciousness
-maybe chronic cough

Question 10

What is the use of medications?

Answer 10

relieve symptoms but also to document reversibility

Question 11

What is the MOA of ICS?

Answer 11

reduce airway inflammation and prevent asthma symptoms

Question 12

What is the onset of ICS?

Answer 12

2 weeks

Question 13

What is crucial regarding ICS to ensure effectiveness and minimization of side effects?

Answer 13

inhaler technique

Question 14

What is the MOA of SABAs?

Answer 14

rapidly relax and open the airways, providing quick relief of symptoms

Question 15

What is key with SABA use?

Answer 15

prn use and not as replacement for controller medication

Question 16

Describe the initiation of a therapeutic trial when a child presents with airway obstruction.

Answer 16

patients presenting with symptoms:
-first step: identify signs of obstruction (active or parental report)
start on SABA +/- oral corticosteroid
assess patient response
-pharmacist follow-up: reassess at appropriate intervals, check adherence and provide plan to caregivers

Question 17

Describe the initiation of a therapeutic trial when a child does not present with signs of airflow obstruction.

Answer 17

1. patient not presenting with obstruction, but report 2 or more episodes of asthma-like symptoms
2. depending on severity and frequency of symptoms
   -prn SABA x 3 months and reassess
   -trial of medium dose ICS and prn SABA x 3 months
3. reassess in 3 months
   -can a dechallenge be initiated?
   -communicate guideline-based plan to caregivers

Question 18

What is the pharmacists role regarding asthma in preschoolers?

Answer 18

not to diagnose but to provide context of what they can expect
ensure the patient is using the medication appropriately (important for efficacy and AE)
efficacy is very important to assess; need to figure out if this will be a long-term medication

Question 19

How can we help to ensure a successful therapeutic trial?

Answer 19

ensure:
-adherence
-adequate inhalation technique
-diligent documentation of signs/symptoms
-timely medical reassessment
try to time medication trial with the season the child is symptomatic (if applicable)

Question 20

How can we help to ensure the medications are indicated for the childs asthma?

Answer 20

confirm the patients asthma symptom history
-airway obstruction
-symptom frequency
confirm therapeutic trial plan
-make sure caregivers understand what they need to do in the next 3 months
-manage their expectations

Question 21

How can we help to ensure the medications are effective for the childs asthma?

Answer 21

check the dose
-prn SABA use is acceptable
-ensure the child is prescribed medium-dose ICS

Question 22

How can the caregivers play a role in ensuring the medications are effective for the childs asthma?

Answer 22

suggest a diary to document symptoms
-change in frequency and severity
-daytime and night time symptoms
-effort limitation
-exacerbations that require medical visits, steroids, or hospital
-rescue SABA use
-absenteeism from usual activities

Question 23

What is an ICS adverse effect that parents might be concerned about? What should we tell them?

Answer 23

growth/adrenal suppression
evidence suggests kids still reach their full height, if anything they might lose a few cm’s but trade off for good asthma control?
-if really concerned, choose an ICS with lower F