Asthma management - Children Flashcards
The goals of treatment are
-“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)
How to measure control?
Closed questions SANE Short acting beta agonist/week Absence school/nursery Nocturnal symptoms/week Excertional symptoms/week
(no change expected)
What is the max dose of ICS for under12s?
800micrograms
What is used as a first line preventer in under 5s?
LTRA
Are Oral B2 tablets, LAMAs and biologicals given to children?
No oral B2 tablets or LAMAs, Only 2 biologicals.
What is used as a regular preventer in children and when does this happen?
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
What are the adverse effects of ICS? Are these common?
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
What 2 things to remember when using an add on preventer (long acting beta agonist)
Do not use without ICS
Use as fixed dose inhaler
If using an MDI (puffer) , what do you also NEED to use
A spacer
Is childhood asthma steroid sensitive
Yes
What 3 things do you need to remember for children using an MDI?
shake, wash and use a spacer!
Shake inhaler between puffs
Wash spacer monthly reduce static
What is the lung deposition with and without a spacer for a child?
<5% lung deposition without spacer
≤20% lung deposition with spacer
What ages can use dry powder devices and what % lung deposition do they achieve?
Girlsaged 8-11 can use as an alternative to MDI spacers.
Achieve 20% lung deposition
What other factors can help children with asthma?
Stop tobacco smoke exposure
Remove environmental triggers:
-Cat, Dog
-HDM (house dust mite)??
What factors have no evidence that they help asthma in children?
Diet – evidence negative
Alter humidity – no evidence
Air ionisers increase cough
Weight reduction – no evidence
How do you choose what asthma medication?
Look at the patient: Respiratory rate Work of breathing Heart rate Oxygen saturations Ability to complete sentences Confusion Air entry
What is SABA?
Short-Acting Beta-Agonists (SABAs). Typically used as “rescue” medications to provide quick relieve of asthma symptoms.
In mild asthma attack what would a child use?
SABA via spacer
SABA via spacer + pred (oral prednisolone)
In moderate asthmatic attack in a child what meds would be used?
SABA via neb + pred
SABA + ipra via neb + pred
Severe asthma attacks in chilren, what do you give them?
IV salbutamol IV aminophylline IV magnesium (neb) IV hydrocortisone Intubate and ventilate
When are oral/inhaled steroids used in children?
Chronic/ maintenance treatment =inhaled steroids (not oral steroids)
Acute treatment =oral steroids(not inhaled steroids)
So the Short Acting Beta Agonist isn’t giving good enough results, what do you add on next?
Long acting beta agonist! (LABA)
WHat do you need to remember when prescribing a LABA?
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)
Which is the only Leukotriene licensed for under 12s? WHy may this be of benefit?
Montelukast
Oral medication, more likely to be taken, powder can be hidden in yoghurt etc.
What should be added to an inhaled steroid if the patient is poorly controlled?
Add on a LABA but keep an open mind, consider additional therapies.
How do you determine wether to administer lighter medication or more heavy/serious meds?
Resp. rate, work of breathing and oxygen saturation
When are nebulisers useful?
In children with moderate severity asthma
