Asthma management - Children

Question 1

The goals of treatment are

Answer 1

-“minimal” symptoms during day and night
-minimal need for reliever medication (less than 2 days/week of reliever treatment)
-no attacks (exacerbations)
-no limitation of physical activity
(normal lung function (in practical terms FEV1 and/or PEF >80% predicted or best) - no change expected)

Question 2

How to measure control?

Answer 2

Closed questions
SANE
Short acting beta agonist/week
Absence school/nursery
Nocturnal symptoms/week
Excertional symptoms/week

(no change expected)

Question 3

What is the max dose of ICS for under12s?

Answer 3

800micrograms

Question 4

What is used as a first line preventer in under 5s?

Answer 4

LTRA

Question 5

Are Oral B2 tablets, LAMAs and biologicals given to children?

Answer 5

No oral B2 tablets or LAMAs, Only 2 biologicals.

Question 6

What is used as a regular preventer in children and when does this happen?

Answer 6

Start very low dose inhaled corticosteroids (or LTRA in <5s)

As a result of diagnostic test: using B2 agonists >two days a week, symptomatic three times a week or more, or waking one night a week.
In rare cases exacerbations of asthma in the last two years

Question 7

What are the adverse effects of ICS? Are these common?

Answer 7

Height suppression
?Oral candidiasis if taken incorrectly
?Adrenocortical suppression* unlikely with brown inhaler

*Particularly with fluticasone, purple and orange inhalers

No, not common, whilst at low to middle doses, there is a great positive impact and low side effects

Question 8

What 2 things to remember when using an add on preventer (long acting beta agonist)

Answer 8

Do not use without ICS

Use as fixed dose inhaler

Question 9

If using an MDI (puffer) , what do you also NEED to use

Answer 9

A spacer

Question 10

Is childhood asthma steroid sensitive

Answer 10

Yes

Question 11

What 3 things do you need to remember for children using an MDI?

Answer 11

shake, wash and use a spacer!

Shake inhaler between puffs
Wash spacer monthly reduce static

Question 12

What is the lung deposition with and without a spacer for a child?

Answer 12

<5% lung deposition without spacer

≤20% lung deposition with spacer

Question 13

What ages can use dry powder devices and what % lung deposition do they achieve?

Answer 13

Girlsaged 8-11 can use as an alternative to MDI spacers.

Achieve 20% lung deposition

Question 14

What other factors can help children with asthma?

Answer 14

Stop tobacco smoke exposure
Remove environmental triggers:
-Cat, Dog
-HDM (house dust mite)??

Question 15

What factors have no evidence that they help asthma in children?

Answer 15

Diet – evidence negative
Alter humidity – no evidence
Air ionisers increase cough
Weight reduction – no evidence

Question 16

How do you choose what asthma medication?

Answer 16

Look at the patient:
Respiratory rate
Work of breathing
Heart rate
Oxygen saturations
Ability to complete sentences
Confusion
Air entry

Question 17

What is SABA?

Answer 17

Short-Acting Beta-Agonists (SABAs). Typically used as “rescue” medications to provide quick relieve of asthma symptoms.

Question 18

In mild asthma attack what would a child use?

Answer 18

SABA via spacer

SABA via spacer + pred (oral prednisolone)

Question 19

In moderate asthmatic attack in a child what meds would be used?

Answer 19

SABA via neb + pred

SABA + ipra via neb + pred

Question 20

Severe asthma attacks in chilren, what do you give them?

Answer 20

IV salbutamol
IV aminophylline
IV magnesium (neb)
IV hydrocortisone
Intubate and ventilate

Question 21

When are oral/inhaled steroids used in children?

Answer 21

Chronic/ maintenance treatment =inhaled steroids (not oral steroids)

Acute treatment =oral steroids(not inhaled steroids)

Question 22

So the Short Acting Beta Agonist isn’t giving good enough results, what do you add on next?

Answer 22

Long acting beta agonist! (LABA)

Question 23

WHat do you need to remember when prescribing a LABA?

Answer 23

Do not use without ICS
(with African-American ancestry if LABA used alone have been reports od sudden death)
Use as fixed dose inhaler (with both ICS and LABA medication in)

Question 24

Which is the only Leukotriene licensed for under 12s? WHy may this be of benefit?

Answer 24

Montelukast

Oral medication, more likely to be taken, powder can be hidden in yoghurt etc.

Question 25

What should be added to an inhaled steroid if the patient is poorly controlled?

Answer 25

Add on a LABA but keep an open mind, consider additional therapies.

Question 26

How do you determine wether to administer lighter medication or more heavy/serious meds?

Answer 26

Resp. rate, work of breathing and oxygen saturation

Question 27

When are nebulisers useful?

Answer 27

In children with moderate severity asthma