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Paediatrics > Asthma Management > Flashcards

Asthma Management Flashcards

1
Q

What are the goals of asthma treatment?

A
  • “Minimal” symptoms during day and night
  • Minimal need for reliever medication
  • No attacks (exacerbations)
  • No limitation of physical activity

-Normal lung function (in practical terms FEV1 and/or PEF >80% predicted or best) - NOT A PRIORITY

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2
Q

Is there a cure for asthma?

A

No cure for asthma, only palliation or spontaneous resolution

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3
Q

Is FEV1 an indicator for asthma?

A

NOT ALWAYS!!

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4
Q

How do you measure asthma control?

A

SANE - find out of poorly controlled
S - Short acting beta agonist/week (>2 times a week)
A - Absence school/nursery
N - Nocturnal symptoms/week (1 night a week)
E - Excertional symptoms/week

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5
Q

What medication change should you make if the asthma is well controlled?

A

No change

Reduce

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6
Q

What medication change should you make if the asthma is poorly controlled?

A

Not taking treatment - don’t change treatment
Not taking treatment correctly - don’t change treatment
Not asthma - stop treatment
None of the above - increase treatment

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7
Q

Asthma treatment has a step up and step-down approach. How do you begin?

A

Low dose ICS

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8
Q

When do you review after first treatment?

A

Review after 2mo

  • No routine test to monitor progress (?)
  • No change easier than down
  • Need an inhaler holiday to confirm diagnosis (Easter) - as coughs and colds are less common in easter
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9
Q

What are the classes of asthma medications

A 
Short acting beta agonists
Inhaled corticosteroids (ICS)
Long acting beta agonists*
Leukotriene receptor antagonists*
Theophyllines*
Oral steroids - uncommon 
* “add ons”
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10
Q

What is the stepwise approach to asthma treatment?

A

BTS/SIGN

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11
Q

How do the child BTS/SIGN guidelines differ from those for adults?

A 
Max dose ICS 800 microg (<12 yo)
No oral B2 tablet
LTRA first line preventer in <5s
No LAMAs
Only two biologicals
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12
Q

When do you introduce a regular preventer (step 2 in old guidelines)?

A

Diagnostic test
B2 agonists > two days a week - GIVEN TO ALL ASTHMATICS
Symptomatic three times a week or more, or waking one night a week
Exacerbations of asthma in the last two years
What with? - not important
Start very low dose inhaled corticosteroids (or LTRA in <5s)

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13
Q

What are the benefits of ICS?

A 
Very useful for diagnosis
Very effective (when taken)
Very safe (when prescribed correctly)
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14
Q

What are the adverse effects of ICS?

A 
Height suppression
Potentially:
-Oral candidiasis
-Adrenocortical suppression* (particularly with fluticasone)
NOT:
-HTN
-Cataracts
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15
Q

What is the next step after ICS?

A

LABA - long-acting beta agonist

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16
Q

What 2 things must you remember when using a LABA?

A

Do not use without ICS

Use as fixed dose inhaler

17
Q

What is another add-on preventer?

A

LTRA - Leukotriene receptor antagonist

18
Q

What are pros of LTRA therapy?

A

Better adherence

Granules for reluctant toddlers

19
Q

What are the causes of severe asthma?

A

50% psychological issues

>50% compliance issues

20
Q

How is severe asthma treated?

A

Experimental medicine

Role of biologics unproven

21
Q

What is the rule of thirds with LTRAs?

A

One third great benefit, one third get a bit of a benefit and in one third, there’s no benefit.

22
Q

What is the best next step after ICS?

A

LABA

Add on LABA or LTRA (BTS/SIGN)
Add on LTRA (NICE)
Increase ICS dose (GINA)

23
Q

How best should you manage asthma?

A

1) Treat “with” and not “to”
2) Recognise individuality - lifestyle and response to treatment
3) Objective PFT (sometimes random and unhelpful)
4) Adherence measured
5) Link Rx to 3 and 4

24
Q

What are the two types of delivery systems?

A

MDI/spacer

Dry powder device

25
Q

How does spacer affect deposition?

A

<5% lung deposition without spacer
≤20% lung deposition with spacer

MDI/spacer = 4x MDI

26
Q

What maintenance should be carried out with inhaler and spacer?

A

Shake inhaler between puffs
Wash spacer monthly reduce static

Shake=2x no shake
Wash = 2 x no wash

27
Q

How does lung deposition change with inhalation?

A

Children should quietly inhale with appropriately fitted mask and not crying

28
Q

Who can use dry powder devices?

A

Licensed in over 5s, under 8s cannot use them

WORK BETTER IN GIRLS

29
Q

How effective are dry powder devices?

A

Achieve 20% lung deposition

30
Q

When are nebulisers indicated?

A

Not for day to day use

31
Q

What makes an MDI/spacer better than a nebuliser?

A 
Quieter
Quicker
Valve mechanism
Don’t break down
Portable
Cheaper
32
Q

What are non-medicinal interventions for asthma?

A

Stop tobacco smoke exposure
Remove environmental triggers
-Cat, Dog
-HDM?? - dust mites

Not proven:
Diet – evidence negative

Alter humidity – no evidence
-Air ionisers increase cough

Weight reduction – no evidence

Paediatrics (37 decks)

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