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Mustafa respiratory > Asthma management - Children > Flashcards

Asthma management - Children Flashcards

1
Q

What are the goals of treatment for asthma?

A
  • “minimal” symptoms during day and night
  • minimal need for reliever medication
  • no exacerbations
  • no limitation of physical activity

normal lung function (in practical terms FEV1 and/or PEF >80% predicted or best

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2
Q

How do you measure control of asthma?

A

SANE

  • Short acting beta agonist/week
  • Absence school/nursery
  • Nocturnal symptoms/week
  • Excertional symptoms/week
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3
Q

What are the classes of medications?

A
  • Short acting beta agonists
  • Inhaled corticosteroids (ICS)
  • Long acting beta agonists*
  • Leukotriene receptor antagonists*
  • Theophyllines*
  • Oral steroids

* “add ons”

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4
Q

What is the blank?

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5
Q

What is the blank?

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6
Q

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7
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8
Q

What is the blank?

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9
Q

When do you review after just starting a course of low dose ICS?

A

2 months

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10
Q

Why stepping down hard?

A

Can’t tell if the aleviation of symptoms is because of treatment or because the patient has spontaneously got better

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11
Q

How does treatment between adults and children contrast?

A
  • Max dose ICS 800 microg
  • No oral B2 tablet
  • LTRA first line preventer in <5s
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12
Q

What is step 1?

A

SABA as required

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13
Q

What is step 2?

A

Regular preventer

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14
Q

When should you prescribe a regular preventer?

A

When using inhaled B2 agonists three times a week or more

When symptomatic three times a week or more, or waking one night a week

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15
Q

What are the regular preventers that you prescribe?

A

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

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16
Q

What is step 3?

A

Add on preventer

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17
Q

What are the three options for adding on preventer?

A
  • Add on LABA
  • Add on LTRA
  • Increase ICS dose
18
Q

What should you do in under 5 patients before prescribing high dose therapies?

A

Refer for confirmation of diagnosis

19
Q

WHat should you do when prescribing continuous or regular oral steroids?

A

REFER!

20
Q

Why are inhaled corticosteroids fab?

A
  • Very useful for diagnosis
  • Very effective (when taken)
  • Very safe (when prescribed correctly) (Large therapeutic range – unlikely to cause harm)
21
Q

What is the general trend in dose response for ICS?

A

Large increase in positive effects for the initial dose of steroids - the rate of increase of positive effects gradually decreases as the dose increases.

22
Q

How do the adverse effects of ICS compare?

A
23
Q

What are the adverse effects of ICS?

A

Height suppression (1cm)

Oral candidiasis?

Adrenocortical suppression?

24
Q

What are the two things to remember about a long acting beta agonist?

A

Do not use without ICS - you can die in you use them on their own

Use as fixed dose inhaler

25
Q

What are the benefits of having a combination inhaler of LABA and ICS?

A

Better compliance as well as potential synergy between the two chemicals

26
Q

What is step 4?

A

Additional add on therapies

27
Q

What is step 5?

A

High dose therapies

28
Q

What is step 6?

A

Experimental medicine

29
Q

What are the possible reasons for the medication not working by stage 6?

A

Psychological issues

Compliance issues

Wrong diagnosis

30
Q

What are the best ways to increase the inhaled dose of an inhaler?

A

For goodness sake shake, wash and use a spacer!

31
Q

Can under 8’s use dry powder devices?

A

no

32
Q

What is important to note about nebulisers?

A

•Not indicated for day-to-day use

33
Q

Why is a MDI better than a nebuliser?

A

Quieter

Quicker

Valve mechanism

Don’t break down

Portable

Cheaper

34
Q

What are the non-pharmocological methods of management?

A

Stop tobacco smoke exposure

Remove environmental triggers

35
Q

What are the treatments for mild acute asthma?

A

SABA via spacer

SABA via spacer and prednisolone

36
Q

What is the treatment for patients for moderate acute asthma?

A

SABA via nebuliser + prednisolone

SABA and ipratropium via nebuliser and prednisolone

37
Q

What are the treatments for patients with severe acute asthma?

A

IV salbutamol

IV aminophyline

IV magnesium

IV hydrocortisone

Intubate and Ventilate

38
Q

How do you make the differential dagnosis between mild, moderate and severe acute asthma treatments?

A

Look at the following features of the patient:

  • Repiratory rate
  • Work of breathing
  • Heart rate
  • Oxygen saturations
  • Ability to complete sentences
  • Confusion - related to hypoxia
  • Air entry
39
Q

What is a measure of work of breathing between children and adults?

A

Subcostal recession in children

Adults - use of accessory muscles

40
Q

What is the overall guide for treatment of acute asthma?

A
  • Start treatment and reassess in 1 hour
  • Step up or down as appropriate
41
Q

When do you use inhaled steroids versus oral?

A
  • Chronic/ maintenance treatment =inhaled steroids
  • Acute treatment =oral steroids – for kids with asthma attac
42
Q
A

Mustafa respiratory (12 decks)

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