Asthma Management - Children

Question 1

What is spontaneous resolution in asthma?

Answer 1

• Patient has asthma but “grows out of it”.

- Asthma might return as an adult though.

Question 2

What are the goals for asthma treatment?

5 points

Answer 2

• “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).

Question 3

What is the SANE mnemonic for measuring control of asthma in children?

Answer 3

• 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.

Question 4

If asthma is not well controlled what must be assessed before treatment is increased?

3 points

Answer 4

• are they taking treatment?
• are they taking treatment correctly?
• do they have asthma?

Question 5

When asthma is suspected what is the treatment to make the diagnosis?

(Step 1)

Answer 5

very low/low dose ICS

SABA when required

Question 6

What is the regular preventer management of asthma?

Step 2

Answer 6

very low dose ICS

or

LTRA for <5years

Question 7

What is the step 3 treatment for asthma in children?

Answer 7

very low dose ICS

+ inhaled LABA for >5years
or
LTRA for <5years

Question 8

What is the step 4 treatment for asthma in children?

Answer 8

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.

Question 9

What is the step 5 treatment of asthma in children?

Answer 9

Increase ICS to medium dose

or

+ 4th drug e.g. SR theophylline

Question 10

What is the step 6 treatment of asthma in children?

Answer 10

Daily steroid tablets in lowest dose to control

Maintain medium dose ICS

Consider other treatments to minimise use of oral steroids.

Question 11

What is the contrast of asthma management in children than with adults?

Answer 11

• Max dose ICS 800 microg (<12 yo)
• No oral B2 tablet
• LTRA first line preventer in <5s
• No LAMAs
• Only two biologicals

Question 12

Are there any LAMAs in control of asthma in children?

Answer 12

No

Question 13

What are the ways that SABAs can be administered in children?

Answer 13

MDI with spacer or dry powder inhaler.

Question 14

What are the adverse effects of ICSs?

Answer 14

• height suppression
• possible oral candidiasis
• adrenocortical suppression*
• hypertension
• cataracts

These side effects only common at high doses though.
*Particularly with fluticasone.

Question 15

What can LABAs not be used without?

Answer 15

ICS

Question 16

What is the LTRA used in children?

Answer 16

Montelukast

Question 17

What are treatments used in the last two steps to minimise the use of steroid tablets?

4 points

Answer 17

• dealing with psychological issues
• dealing with compliance issues
• question the diagnosis
• experimental medicine

Question 18

What are the important steps to take when using MDI?

3 points

Answer 18

Shake
Use spacer
Wash spacer

Question 19

What are the non-pharmacological treatments of asthma in children?

Answer 19

• Patient education
• Remove triggers
• Avoid smoke exposure

Question 20

What signs are used to determine the severity of acute asthma?

Answer 20

Respiratory rate
Work of breathing
Heart rate
Oxygen saturations
Ability to complete sentences
Confusion
Air entry

Question 21

What is the treatment for mild acute asthma?

Answer 21

SABA via spacer

SABA via spacer and prednisolone

Question 22

What is the treatment for moderate acute asthma?

Answer 22

SABA via nebuliser and prednisolone

SABA + ipratropium via nebuliser and prednisolone

Question 23

What is the treatment for severe acute asthma?

Answer 23

IV salbutamol
IV aminophylline
IV magnesium
IV hydrocortisone
Intubate and ventilate

Question 24

What sort of steroids are used for acute asthma?

Answer 24

Oral steroids

Question 25

What sort of steroids are used for chronic asthma?

Answer 25

ICS

Question 26

What should you do for acute asthma reactions?

Answer 26

Start treatment and reassess in 1 hour

Step up or down as appropriate