Asthma Management - Children Flashcards
What is spontaneous resolution in asthma?
- Patient has asthma but “grows out of it”.
- Asthma might return as an adult though.
What are the goals for asthma treatment?
5 points
- “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 is the SANE mnemonic for measuring control of asthma in children?
- Short acting beta agonist/week (using more than 3 times a week).
- Absence school/nursery
- Nocturnal symptoms/week (one times a week or more)
- Excertional symptoms/week
Information gathered using closed questions.
If asthma is not well controlled what must be assessed before treatment is increased?
3 points
- are they taking treatment?
- are they taking treatment correctly?
- do they have asthma?
When asthma is suspected what is the treatment to make the diagnosis?
(Step 1)
very low/low dose ICS
SABA when required
What is the regular preventer management of asthma?
Step 2
very low dose ICS
or
LTRA for <5years
What is the step 3 treatment for asthma in children?
very low dose ICS
+ inhaled LABA for >5years
or
LTRA for <5years
What is the step 4 treatment for asthma in children?
If no response to LABA (stop LABA) and increase to low dose of ICS
or
Ff benefit from LABA (continue LABA) and increase ICS dose
or
Continue both + add in other therapy, e.g. LTRA.
What is the step 5 treatment of asthma in children?
Increase ICS to medium dose
or
+ 4th drug e.g. SR theophylline
What is the step 6 treatment of asthma in children?
Daily steroid tablets in lowest dose to control
Maintain medium dose ICS
Consider other treatments to minimise use of oral steroids.
What is the contrast of asthma management in children than with adults?
- Max dose ICS 800 microg (<12 yo)
- No oral B2 tablet
- LTRA first line preventer in <5s
- No LAMAs
- Only two biologicals
Are there any LAMAs in control of asthma in children?
No
What are the ways that SABAs can be administered in children?
MDI with spacer or dry powder inhaler.
What are the adverse effects of ICSs?
- height suppression
- possible oral candidiasis
- adrenocortical suppression*
- hypertension
- cataracts
These side effects only common at high doses though.
*Particularly with fluticasone.
What can LABAs not be used without?
ICS
What is the LTRA used in children?
Montelukast
What are treatments used in the last two steps to minimise the use of steroid tablets?
4 points
- dealing with psychological issues
- dealing with compliance issues
- question the diagnosis
- experimental medicine
What are the important steps to take when using MDI?
3 points
Shake
Use spacer
Wash spacer
What are the non-pharmacological treatments of asthma in children?
- Patient education
- Remove triggers
- Avoid smoke exposure
What signs are used to determine the severity of acute asthma?
Respiratory rate Work of breathing Heart rate Oxygen saturations Ability to complete sentences Confusion Air entry
What is the treatment for mild acute asthma?
SABA via spacer
SABA via spacer and prednisolone
What is the treatment for moderate acute asthma?
SABA via nebuliser and prednisolone
SABA + ipratropium via nebuliser and prednisolone
What is the treatment for severe acute asthma?
IV salbutamol IV aminophylline IV magnesium IV hydrocortisone Intubate and ventilate
What sort of steroids are used for acute asthma?
Oral steroids
What sort of steroids are used for chronic asthma?
ICS
What should you do for acute asthma reactions?
Start treatment and reassess in 1 hour
Step up or down as appropriate
