Asthma Management Children Flashcards
What guidelines are available
BTS/SIGN - UK,Australia and EU
GINA - America
NICE - UK
What are the 5 goals of treatment
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)
What acronym can be used to assess a patients control of asthma
SANE
What does SANE stand for
Short acting beta agonist/week
Absence school/nursery
Nocturnal symptoms/week
Excertional symptoms/week
What question can be asked to assess S in SANE
How many days a week do you need your blue inhaler?
More than 3 days indicates that the asthma is poorly controlled
What does A in SANE indicate
It is a quality of life indicator
How may you know that a patients asthma is poorly controlled using N in SANE
If nocturnal symptoms occur more than once a week it indicates that the asthma is poorly controlled
What should be done if the patients asthma is well controlled
The medication can either be reduced or nothing changed
What should be done if the patients asthma is not well controlled
Check that:
Treatment is being taken
Treatment is being taken correctly
If they have asthma
If it is found that the treatment is not being taken or not being taken correctly, what should be done
Nothing (no change to asthma treatment)
Reiterate compliance
Teach technique
If it is found that they are taking their treatment and they are taking it correctly, what should be done
Dose may be increased
What dose of ICS should a patient be started on and why
Low dose of ICS
Even severe asthma may be able to respond to minimal treatment
When should the treatment given to the patient be reviewed
After 2 months
Is there a routine test to monitor the patients progress
No
What are the 6 classes of medications
Short acting beta agonists - blue Inhaled corticosteroids (ICS) Long acting beta agonists Leukotriene receptor antagonists Theophyllines Oral steroids
Which medications are known as add ons
Long acting beta agonists
Leukotriene receptor antagonists
Theophyllines
What has changed in the 2016 BTS/SIGN guidelines
It now provides one figure for all children and adults
The ICS doses overlap between children and adults
It acknowledges the areas of uncertainty when ICS are not sufficient
What are the ICS doses available
Very low
Low
Medium
High
What are the 5 differences between treatment in adults and children
Maximum dose of ICS in children is 800mg There is no oral β2 tablet LTRA is the first line preventer in under 5’s There are no LAMA’s There is only one biological product
What is the first step of asthma treatment in children
SABA as required
The child should be provided inhaled (not oral) short acting beta agonists with a spacer/MDI or a dry powder inhaler
What is the second step of treatment
Use of a regular preventer
In what 3 circumstances should the child be given the 2nd step of treatment
When:
They are using inhaled β2 agonists three or more times a week
They are symptomatic three or more times a week or waking up one night a week
When they have had exacerbations of asthma in the last two years
What should the 2nd step of treatment be started with
Very low dose of inhaled corticosteroids
LTRA in under 5’s
What is done in step 3 of treatment
An add on preventer is added on
What three choices are available in step 3
You can either:
Add on LABA
Add on LTRA
Increase ICS dose
Which guideline says that in step 3 a LABA should be added on
BTS/SIGN
Which guideline says that in step 3 a LTRA should be added on
NICE
Which guideline says that in step 3 an increase in ICS dose should be given
GINA
What did evidence show in regards to the treatment options available in step 3
182 children had 16 weeks of each treatment
LABA produced the best response in 45% of children
ICS produced the best response in 30% of children
LTRA produced the best response in 25% of children
What is the best treatment option in step 3
Add on LABA but keep an open mind
What are three benefits of inhaled cortcosteriods
Very useful for diagnosis Very effective (when taken) Very safe (when prescribed correctly)
Does doubling the dose of ICS once have a beneficial response
Yes
Does doubling the dose of ICS twice have a beneficial response
No
What is a disadvantage of increasing the dose of ICS
Increased risk of adverse effects
What are 3 adverse effects of ICS use
Height suppression
Oral candidiasis
Adrenocortical suppression
How severe is the height suppression seen in 4-11 year olds using ICS
A height reduction of 0.5-1cm in adulthood
How can the risk of oral candidiasis be reduced
By brushing your teeth after inhaler use
What does adrenocortical supression stop the production of
Steriods
What does ICS not cause
Hypertension
Cataracts
Which type of ICS is known to cause adrenocortical supression
Fluticasone
What must long acting beta agonist be used with
ICS
If not it can be fatal
Can long acting beta agonists be used as a fixed dose inhaler
Yes
Give an example of a leukotriene receptor antagonist
Montelukast
What do leukotriene receptor antagonists do
Block leukotriene pathways
Give 2 benefits of leukotriene receptor antagonist
Have better adherence in patients
Available as a tablet or granule for toddlers
What does step 6 of treatment involve
Experimental medicine
What issues have been seen in step 6 of treatment
50% of patients have psychological issues
Over 50% of patients have compliance issues
What should be questioned once step 6 of treatment has been reached
The diagnosis of asthma
Only a minority have the genuine severe disease
What 2 types of delivery systems are available
MDI/spacer
Dry powder device
How much of the drug is deposited in to the lung without a spacer
Under 5%
