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
How do you practice asthma medication?
- You should do it with someone and not to someone
- Make sure you consider individuality in terms of lifestyle and response to treatment.
- objective tests can be used sometimes but don’t use them all the time because sometimes they are just random number generators.
What are the two delivery methods for asthma treatment?
- Metered-dose inhaler/ spacer
- Dry powder device
What percentage of the drug do you get itno your lungs without a spacer?
About 5%
How much of the drug do you get into your lungs with a spacer?
About 20%
How can you further increase the efficacy of an inhaler?
By shaking it between puffs.
What things are really important when using a spacer?
Shake it between puffs
Wash the spacer once a month
Who are dry powder devices licensed or and who can’t use them?
They are licensed for over 5s but under 8s can’t use them, owners of a y chromosome cant use them either.
What can you do to improve a childs asthma without medication?
- Stop smoking
- Remove environmental triggers
What treatments can you use for mild acute asthma?
Short-acting beta-agonists via a spacer and if they still have a few symptoms you can give them some oral prednisolone as well.
What factors should you look at when trying to figure out what medication to use?
Respiratory Rate Work of breathing Heart rate Oxygen saturations Ability to complete sentences Confusion Air entry
For acute asthma, after how long would you review them?
After one hour
What kind of treatment do you give in chronic/maintainence treatment?
Inhaled steroids
What kind of treatment do you give in acute treatment?
Oral steroids
Why is stepping down hard?
Can’t tell if the alleviation of symptoms is because of treatment or because the patient has spontaneously gotten better.
What is step 1?
SABA as required
What is step 2?
Regular preventer
What is step 3?
Add on a preventer
What should you do in under 5s before prescribing high dose therapies?
Refer for confirmation of diagnosis.
What should you do when prescribing continous or regular oral steroids?
REFER
Why are inhaled corticosteroids good?
Very useful diagnosis, very effective, very safe
What is the general trend in dose response for ICS?
Large increase in positive effects for the initial dose of steroids - the rate of increase of positive effects gradually decreases as the dose increases.
What are the benefits of having a combination inhaler of LABA and ICS?
Better compliance as well as potential synergy between the two chemicals
What is step 4?
Additional add on therapies.
What is step 5?
High dose therapies
What is step 6?
Experimental medicine
What are the possible reasons for the medication not working by stage 6?
Psychological issues, Compliance issues, Wrong diagnosis
Can under 8’s use dry powder devices?
No
What is important to note about nebulisers?
Not indicated for day-to-day use.
Why is a MDI better than a nebuliser?
Quieter, Quicker, Valve mechanism, Don’t break down, Portable, Cheaper
What is the treatment for patients for moderate acute asthma?
SABA via nebuliser + prednisolone
SABA and ipratropium via nebuliser and prednisolone
What are the treatments for patients with severe acute asthma?
IV salbutamol, IV aminophyline, IV magnesium, IV hydrocortisone, Intubate and Ventilate
What is a measure of work of breathing between children and adults?
Subcostal recession in children, Adults - use of accessory muscles
When do you use inhaled steroids versus oral?
Chronic/ maintenance treatment = inhaled steroids.
Acute treatment =oral steroids – for kids with asthma attack
