Asthma management children - not done

Question 1

What aspects of a child’s history indicate poor control of asthma?

Answer 1

SANE

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

Question 2

How can you investigate a child’s control of asthma?

Answer 2

History - ‘SANE questions’

Have them complete a Childhood ACT (questionnaire)

Question 3

Before changing a patients medication for asthma, what must you check?

Answer 3

Compliance with treatment

Correct technique for using inhalers

Consider possibility of another diagnosis

Question 4

A child is unable to control their asthma effectively and requires a ‘regular preventer’

What do you add to their treatment regime?

Answer 4

Add Very low dose ICS

So theyre on SABA and VL dose ICS

Review after 2 months

Question 5

How is the starting point for therapy different in children under 5?

Answer 5

LTRA first line preventer in <5s

Question 6

How is the treatment for children different from adults?

Answer 6

Max dose ICS 800 microg (<12 yo)

No oral B2 agonist tablet

No LAMAs

Only two biologicals

Question 7

Why would you change a child’s therapy regime up to using a regular preventer? (VL dose ICS)

Answer 7

If a Diagnostic test indicates that you should

B2 agonists 3 or more days per week

Symptomatic three times a week or more

Waking one night a week.

Exacerbations of asthma in the last two years

Question 8

What are the adverse effects of ICS?

Answer 8

Height suppression

Oral candidiasis

Adrenocortical suppression - particularly with Fluticasone

Question 9

Describe the agents used in:

‘Initial add on preventer’

Answer 9

On top of SABA and Very low dose ICS, you would add:

LABA - if 5 or over

LTRA - if younger than 5

Question 10

How are LABA’s administered?

Answer 10

Fixed dose inhaler

Always alongside ICS - often combination inhaler

Question 11

A child in on a SABA, Very low dose ICS and a LABA but symptoms are still persisting

What is the next step?

Answer 11

If LABA not working - stop LABA and increase dose of ICS to ‘low dose’

or

Continue LABA and increase dose of ICS to ‘low dose’

or

Continue LABA, very low dose ICS and add an LTRA (montelukast)

Question 12

‘Additional add on therapies’ does not control a child’s asthma

What is the next step?

Answer 12

‘High dose therapies’

Consider trials of:

Increasing ICS to a medium dose
or
Addition of 4th drug - SR theophylline

Refer for specialist care

Question 13

What is the final stage for control of asthma in children?

Answer 13

Addition of oral steroid tablet

Maintain medium dose ICS

Consider other treatments to minimise the use of steroid tablet