Asthma Management in Children Flashcards
What is the most important thing to remember when diagnosing asthma?
No wheeze, no asthma
What can you say about a cure for asthma?
There is no cure, only palliation or spontaneous resolution
What are the goals of asthma treatment?
Minimal symptoms during the day and night
Minimal need for reliever medication
No attacks (exacerbations)
No limitations of physical activity
Normal lung function (FEV1 > 70%)
What is the acronym for measuring the control of asthma?
SANE
Short acting beta agonist/week
Absence from school
Nocturnal symptoms/week
Exertional symptoms/week
What must be asked when deciding to treat if the asthma is well controlled?
No change?
Reduce?
What must be asked when deciding to treat when symptoms are not well controlled?
Not taking the treatment? (no change)
Not taking treatment correctly? (no change)
Not asthma? (stop asthma treatment)
None of the above? (increase treatment)
What is the step up and step down approach?
Start on a low dose
Review after 2 months
Why do you start on a low dose and increase after reviews?
Severe may respond to minimal treatment
It is easier to step up than down
What are some different classes of asthma medicine?
Short acting beta agonist
Inhaled corticosteroids (ICS)
Long acting beta agonist
Leukotriene receptor antagonist
Theophylline
Oral steroids
What does ICS stand up for?
Inhaled corticosteroids
What should you remember about the guidelines for the treatment of asthma from country to country?
They may change
What are contrasts between childrens medication and adults?
Max dose ICS 800mg
No oral B2 tablet
LTRA first line prevent in <5s
No LAMAs
What is the max dose of ICS for children?
800mg
What does LAMA stand up for?
Long acting muscarinic antagonist
When should you use a regular inhaler?
B2 agonist > 2 times per week
Symptomatic 3 times a week or more, or waking one night a week
What should be used as a regular inhaler if required?
Very low dose corticosteroids (or LTRA in <5s)
What does LTRA stand up for?
Leukotreine receptor antagonist
What are advantages of inhaled corticosteroids?
Very useful for diagnosis
Very effective
Very safe
What should be remembered about increasing the dose of ICS?
Positive effects plateua while adverse effects increase
What are some adverse effects of ICS?
Height suppresion
Oral candidiasis
Adrenocortical suppresion
Hypertension
Cataracts
What could be used as additional add on preventors?
LABA or LTRA
LTRA
Increase ICS dose
What 2 things should be remembered about long acting beta agonists (LABA)?
Do not use without ICS
Use as a fixed dose inhaler
What is the drug used as a leukotriene receptor antagonist?
Montelukast
What is montelukast?
Leukotriene receptor antagonist
What are advantages of leukotriene receptor antagonists?
Better adherance
Granules for reluctant toddlers
What are high dose therpies used for in under 5s?
Confirmation of diagnosis
What should you do if a high dose therapy is required for over 5s?
Increase to medium dose ICS and consider referral
What should be done if no changes to asthma treatment allows the control of the asthma?
Experimental medicine
50% psychological issues
>50% compliance issues
Question the diagnosis
Minority with genuine severe disease
What are the 2 kinds of delivery systems?
MDI/spacer
Dry powder device (DPD)
What should be remembered about children compared to adults?
They are less compliant
How should inhalers be used?
Shake inhaler between puffs
Eash spacer monthly to reduce static
Each of these things increases delivery by 100%
What should you do to the inhaler between puffs?
Shake it
How often should the inhaler be washes?
Once per month
What does washing the inhaler and shaking it increase delivery by?
100%
How does using a spacer increase delivery?
4x medicine goes to the lungs than had you not used it
How much of a drug reaches the lungs when the inhaler is used with a not tightly fitted face mask?
0.1%
How much of the drug reaches the lungs when the child is crying?
1%
How much of the drug reaches the lungs when the child is quietly inhaling?
8%
What age is allowed to use dry powdered devices?
Licensed in over 5s (but under 8s cannot use them)
What lung deposition does dry powder devices achieve?
20%
Why is an MDI spacer better than a nebuliser?
Quieter
Quicker
Valve mechanism
Don’t break down
Portable
Cheaper
What are some non-medical interventions?
Stop tobacco smoke exposure
Remove environmental triggers
What are some non-medical interventions that people believe, but are not proven by clinical evidence?
Diet
Alter humidity
Weight reduction
What needs to be considered when deciding which medication to use?
Respiratory rate
Work of breathing
Heart rate
Oxygen saturations
Ability to complete sentences
Confusion
Air entry
What medicine should be used for mild severity?
SABA with spacer
What medicine should be used for moderate severity?
SABA with nebuliser
What medicine should be used for severe severity?
IV salbutamol
IV aminophylline
IV magnesium
IV hydrocortisone
What should you do for acute asthma reactions?
Start treatment and reassess in 1 hour
Step up or down as appropriate
What kind of steroids should be used for chronic/maintanence treatment?
Inhaled steroids
What kinds of steroids should be used for acute treatment?
Oral steroids
What does SIGN stand up for?
Scottish Intercollegiate Guidelines Network
What does BTSG stand up for?
British Thoracic Society Guidelines
What approach does SIGN and BTSG use to asthma treatment?
Stepwise approach
What is step 1 to 5 of asthma treatment?
1) Regular preventor
2) Initial add-on preventor
3) Additional add-on therapies
4) High-dose therapies
5) Continuous or frequent use of oral steroids
