Asthma Management in Children Flashcards
Is there a cure for asthma?
No
What are the goals of treatments for asthma?
- minimal symptoms during the day and night.
- minimal need for reliever medication (inhaler)
- no attacks
- no limitations to physical activity
How do you figure out what questions to ask for asthmatics?
- Closed questions
- SANE
- Short acting beta agonist (are you using your blue inhaler more than two times a week?)
- Absences (Have you had any absences)
- Nocturnal symptoms/week (Do you wake up more than one night a week to cough or wheeze?)
- Exertional symptoms/week
What are complex treatment decisions in asthma?
- Are symptoms controlled?
- Is treatment being taken?
- Will this treatment change help?
- If their asthma is well controlled: No change or reduce their treatment.
- If not well controlled: Not taking treatment, not taking treatment correctly, not asthma, none of the above?
What is the step up and step down approach for asthma?
- Started on low dose ICS
- Check again after 2 months: ( no diagnostic test to monitor progress, it easier to make no change than to go down)
- Give them an inhaler holiday in Easter.
Can severe asthma respond to minimal treatment?
Yes
Why are inhaler holidays given in Easter?
Because coughs and colds are less prevalent in easter time.
What are the six classes of medications used for asthma?
- Short acting beta agonist
- Inhaled conrticosteroids
- Long acting beta agonists
- Leukotriene receptor antagonists
- Theophyllines
- Oral steroids
What is the short acting beta agonist?
Blue relieving inhaler
What are inhaled cortico steroids?
They are the satandard preventers.
Which medications are add on medications?
long acting beta agonists, leukotriene beta antagonists and theophyllines.
What does the guideline for diagnosing patients now look like?
- ## Trial of treatment to confirm their diagnosis: if symptoms are well controlled they stay on it, if they haven’t had a any symptoms for 3 months then you stop the treatment.
What is the maximum dose of inhaled steroids for children under 12?
800mg which is less than that of adults.
Do adults have an oral B2 tablet?
No
What are the two first line preventers that can be used for children under the age of 5?
Inhaled corticosteroids or leukotriene receptor antagonists
Do we have any long acting muscarinic antagonists?
No
When do we use a regular preventer?
When you are doing a diagnostic test or if they have to use a beta 2 agonist more than twice a week, also if they’re symptomatic three days a week or more or if they are waking one night a week.
What are the adverse effects of ICS?
They have a height suppression (final adult height is reduced by 0.5cm to 1cm)
- If you don’t wash your teeth after using the brown inhaler you might get a bit of oral thrush.
- Supress ones own steroid production (highly uncommon with the brown inhaler, but purple and orange can)
- oral steroids can cause hypertension and cataracts, but inhaled ones don’t.
What are the two thinsg to remember about long acting beta agonists?
Do not use without ICS and use as a fixed-dose inhaler
What are the main important facts about leukotriene receptor antagonists?
- the only molecule that is licensed to be used at the moment is montelukast
- It is based on the rule of thirds.
- There is better adherence.
- Granules of singulair
What is the rule of thirds?
One thirds find benefit from it, One third find some benefit from it and the final third find no benefit from it.
What is the adherence of oral medication in the UK?
70%
What is the adherence of inhaled medication?
30 - 50 %
What are the three treatment options when a patient’s asthma is poorly controlled on low dose inhaled steroid?
- Add on LABA or LTRA (Long-acting beta-agonist, Leukotriene receptor antagonists) (BTS/SIGN)
- Add on LTRA
- Increase ICS dose
