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Respiratory System & CVS Physiology Year 1 > Asthma Management in Children > Flashcards

Asthma Management in Children Flashcards

1
Q

Is there a cure for asthma?

A

No

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2
Q

What are the goals of treatments for asthma?

A
  • minimal symptoms during the day and night.
  • minimal need for reliever medication (inhaler)
  • no attacks
  • no limitations to physical activity
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3
Q

How do you figure out what questions to ask for asthmatics?

A
  • 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
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4
Q

What are complex treatment decisions in asthma?

A
  • 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?
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5
Q

What is the step up and step down approach for asthma?

A
  • 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.
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6
Q

Can severe asthma respond to minimal treatment?

A

Yes

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7
Q

Why are inhaler holidays given in Easter?

A

Because coughs and colds are less prevalent in easter time.

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8
Q

What are the six classes of medications used for asthma?

A
  • Short acting beta agonist
  • Inhaled conrticosteroids
  • Long acting beta agonists
  • Leukotriene receptor antagonists
  • Theophyllines
  • Oral steroids
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9
Q

What is the short acting beta agonist?

A

Blue relieving inhaler

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10
Q

What are inhaled cortico steroids?

A

They are the satandard preventers.

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11
Q

Which medications are add on medications?

A

long acting beta agonists, leukotriene beta antagonists and theophyllines.

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12
Q

What does the guideline for diagnosing patients now look like?

A
  • ## 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.
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13
Q

What is the maximum dose of inhaled steroids for children under 12?

A

800mg which is less than that of adults.

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14
Q

Do adults have an oral B2 tablet?

A

No

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15
Q

What are the two first line preventers that can be used for children under the age of 5?

A

Inhaled corticosteroids or leukotriene receptor antagonists

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16
Q

Do we have any long acting muscarinic antagonists?

A

No

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17
Q

When do we use a regular preventer?

A

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.

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18
Q

What are the adverse effects of ICS?

A

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.
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19
Q

What are the two thinsg to remember about long acting beta agonists?

A

Do not use without ICS and use as a fixed-dose inhaler

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20
Q

What are the main important facts about leukotriene receptor antagonists?

A
  • 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
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21
Q

What is the rule of thirds?

A

One thirds find benefit from it, One third find some benefit from it and the final third find no benefit from it.

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22
Q

What is the adherence of oral medication in the UK?

A

70%

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23
Q

What is the adherence of inhaled medication?

A

30 - 50 %

24
Q

What are the three treatment options when a patient’s asthma is poorly controlled on low dose inhaled steroid?

A
  • Add on LABA or LTRA (Long-acting beta-agonist, Leukotriene receptor antagonists) (BTS/SIGN)
  • Add on LTRA
  • Increase ICS dose
25
Q

How do you practice asthma medication?

A
  • 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.
26
Q

What are the two delivery methods for asthma treatment?

A
  • Metered-dose inhaler/ spacer

- Dry powder device

27
Q

What percentage of the drug do you get itno your lungs without a spacer?

A

About 5%

28
Q

How much of the drug do you get into your lungs with a spacer?

A

About 20%

29
Q

How can you further increase the efficacy of an inhaler?

A

By shaking it between puffs.

30
Q

What things are really important when using a spacer?

A

Shake it between puffs

Wash the spacer once a month

31
Q

Who are dry powder devices licensed or and who can’t use them?

A

They are licensed for over 5s but under 8s can’t use them, owners of a y chromosome cant use them either.

32
Q

What can you do to improve a childs asthma without medication?

A
  • Stop smoking

- Remove environmental triggers

33
Q

What treatments can you use for mild acute asthma?

A

Short-acting beta-agonists via a spacer and if they still have a few symptoms you can give them some oral prednisolone as well.

34
Q

What factors should you look at when trying to figure out what medication to use?

A 
Respiratory Rate
Work of breathing 
Heart rate
Oxygen saturations 
Ability to complete sentences
Confusion 
Air entry
35
Q

For acute asthma, after how long would you review them?

A

After one hour

36
Q

What kind of treatment do you give in chronic/maintainence treatment?

A

Inhaled steroids

37
Q

What kind of treatment do you give in acute treatment?

A

Oral steroids

38
Q

Why is stepping down hard?

A

Can’t tell if the alleviation of symptoms is because of treatment or because the patient has spontaneously gotten better.

39
Q

What is step 1?

A

SABA as required

40
Q

What is step 2?

A

Regular preventer

41
Q

What is step 3?

A

Add on a preventer

42
Q

What should you do in under 5s before prescribing high dose therapies?

A

Refer for confirmation of diagnosis.

43
Q

What should you do when prescribing continous or regular oral steroids?

A

REFER

44
Q

Why are inhaled corticosteroids good?

A

Very useful diagnosis, very effective, very safe

45
Q

What is the general trend in dose response for ICS?

A

Large increase in positive effects for the initial dose of steroids - the rate of increase of positive effects gradually decreases as the dose increases.

46
Q

What are the benefits of having a combination inhaler of LABA and ICS?

A

Better compliance as well as potential synergy between the two chemicals

47
Q

What is step 4?

A

Additional add on therapies.

48
Q

What is step 5?

A

High dose therapies

49
Q

What is step 6?

A

Experimental medicine

50
Q

What are the possible reasons for the medication not working by stage 6?

A

Psychological issues, Compliance issues, Wrong diagnosis

51
Q

Can under 8’s use dry powder devices?

A

No

52
Q

What is important to note about nebulisers?

A

Not indicated for day-to-day use.

53
Q

Why is a MDI better than a nebuliser?

A

Quieter, Quicker, Valve mechanism, Don’t break down, Portable, Cheaper

54
Q

What is the treatment for patients for moderate acute asthma?

A

SABA via nebuliser + prednisolone

SABA and ipratropium via nebuliser and prednisolone

55
Q

What are the treatments for patients with severe acute asthma?

A

IV salbutamol, IV aminophyline, IV magnesium, IV hydrocortisone, Intubate and Ventilate

56
Q

What is a measure of work of breathing between children and adults?

A

Subcostal recession in children, Adults - use of accessory muscles

57
Q

When do you use inhaled steroids versus oral?

A

Chronic/ maintenance treatment = inhaled steroids.

Acute treatment =oral steroids – for kids with asthma attack

Respiratory System & CVS Physiology Year 1 (58 decks)

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