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Respiratory System DO > Asthma Management Children > Flashcards

Asthma Management Children Flashcards

1
Q

What guidelines are available

A

BTS/SIGN - UK,Australia and EU
GINA - America
NICE - UK

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2
Q

What are the 5 goals of 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)
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3
Q

What acronym can be used to assess a patients control of asthma

A

SANE

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4
Q

What does SANE stand for

A

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

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5
Q

What question can be asked to assess S in SANE

A

How many days a week do you need your blue inhaler?

More than 3 days indicates that the asthma is poorly controlled

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6
Q

What does A in SANE indicate

A

It is a quality of life indicator

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7
Q

How may you know that a patients asthma is poorly controlled using N in SANE

A

If nocturnal symptoms occur more than once a week it indicates that the asthma is poorly controlled

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8
Q

What should be done if the patients asthma is well controlled

A

The medication can either be reduced or nothing changed

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9
Q

What should be done if the patients asthma is not well controlled

A

Check that:
Treatment is being taken
Treatment is being taken correctly
If they have asthma

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10
Q

If it is found that the treatment is not being taken or not being taken correctly, what should be done

A

Nothing (no change to asthma treatment)
Reiterate compliance
Teach technique

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11
Q

If it is found that they are taking their treatment and they are taking it correctly, what should be done

A

Dose may be increased

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12
Q

What dose of ICS should a patient be started on and why

A

Low dose of ICS

Even severe asthma may be able to respond to minimal treatment

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13
Q

When should the treatment given to the patient be reviewed

A

After 2 months

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14
Q

Is there a routine test to monitor the patients progress

A

No

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15
Q

What are the 6 classes of medications

A 
Short acting beta agonists - blue
Inhaled corticosteroids (ICS)
Long acting beta agonists
Leukotriene receptor antagonists
Theophyllines
Oral steroids
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16
Q

Which medications are known as add ons

A

Long acting beta agonists
Leukotriene receptor antagonists
Theophyllines

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17
Q

What has changed in the 2016 BTS/SIGN guidelines

A

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

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18
Q

What are the ICS doses available

A

Very low
Low
Medium
High

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19
Q

What are the 5 differences between treatment in adults and children

A 
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
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20
Q

What is the first step of asthma treatment in children

A

SABA as required

The child should be provided inhaled (not oral) short acting beta agonists with a spacer/MDI or a dry powder inhaler

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21
Q

What is the second step of treatment

A

Use of a regular preventer

22
Q

In what 3 circumstances should the child be given the 2nd step of treatment

A

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

23
Q

What should the 2nd step of treatment be started with

A

Very low dose of inhaled corticosteroids

LTRA in under 5’s

24
Q

What is done in step 3 of treatment

A

An add on preventer is added on

25
Q

What three choices are available in step 3

A

You can either:
Add on LABA
Add on LTRA
Increase ICS dose

26
Q

Which guideline says that in step 3 a LABA should be added on

A

BTS/SIGN

27
Q

Which guideline says that in step 3 a LTRA should be added on

A

NICE

28
Q

Which guideline says that in step 3 an increase in ICS dose should be given

A

GINA

29
Q

What did evidence show in regards to the treatment options available in step 3

A

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

30
Q

What is the best treatment option in step 3

A

Add on LABA but keep an open mind

31
Q

What are three benefits of inhaled cortcosteriods

A 
Very useful for diagnosis
Very effective (when taken)
Very safe (when prescribed correctly)
32
Q

Does doubling the dose of ICS once have a beneficial response

A

Yes

33
Q

Does doubling the dose of ICS twice have a beneficial response

A

No

34
Q

What is a disadvantage of increasing the dose of ICS

A

Increased risk of adverse effects

35
Q

What are 3 adverse effects of ICS use

A

Height suppression
Oral candidiasis
Adrenocortical suppression

36
Q

How severe is the height suppression seen in 4-11 year olds using ICS

A

A height reduction of 0.5-1cm in adulthood

37
Q

How can the risk of oral candidiasis be reduced

A

By brushing your teeth after inhaler use

38
Q

What does adrenocortical supression stop the production of

A

Steriods

39
Q

What does ICS not cause

A

Hypertension

Cataracts

40
Q

Which type of ICS is known to cause adrenocortical supression

A

Fluticasone

41
Q

What must long acting beta agonist be used with

A

ICS

If not it can be fatal

42
Q

Can long acting beta agonists be used as a fixed dose inhaler

A

Yes

43
Q

Give an example of a leukotriene receptor antagonist

A

Montelukast

44
Q

What do leukotriene receptor antagonists do

A

Block leukotriene pathways

45
Q

Give 2 benefits of leukotriene receptor antagonist

A

Have better adherence in patients

Available as a tablet or granule for toddlers

46
Q

What does step 6 of treatment involve

A

Experimental medicine

47
Q

What issues have been seen in step 6 of treatment

A

50% of patients have psychological issues

Over 50% of patients have compliance issues

48
Q

What should be questioned once step 6 of treatment has been reached

A

The diagnosis of asthma

Only a minority have the genuine severe disease

49
Q

What 2 types of delivery systems are available

A

MDI/spacer

Dry powder device

50
Q

How much of the drug is deposited in to the lung without a spacer

A

Under 5%

Respiratory System DO (33 decks)

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