asthma management in children

Question 1

what is spontaneous resolution in asthma?

Answer 1

patient has asthma but “grows out of it”. asthma might return as an adult though

Question 2

what are the goals for asthma treatment?

Answer 2

minimal symptoms during day and night
minimal need for reliever medication
no attacks (exacerbations)
no limitation of physical activity
normal lung function (in practical terms FEV1 and PEF > 80% predicted or best)

Question 3

what is the SANE mnemonic for measuring control of asthma in children?

Answer 3

short acting beta agonist (using more than 3 times a week)
absence from nursery or school
nocturnal symptoms (one times a week or more)
excertional symptoms

Question 4

if asthma is not well controlled what must be assessed before treatment is increased?

Answer 4

are they taking treatment?
are they taking treatment correctly?
do they have asthma?

Question 5

when asthma is suspected what is the treatment to make the diagnosis?

Answer 5

very low to low dose ICS

Question 6

what is the regular preventer management of asthma, step 2?

Answer 6

very low dose ICS or LTRA for <5years

Question 7

what is the step 3 treatment for asthma in children?

Answer 7

very low dose ICS plus LABA for >/= 5years

or LTRA for <5years

Question 8

what is the step 4 treatment for asthma in children?

Answer 8

i there is no response to LABA, stop LABA and increase dose of ICS
or
if benefit from LABA then keep LABA and increase ICS dose
or
if benefit from LABA then keep LABA and ICS and add in other therapy, LTRA

Question 9

what is the step 5 treatment of asthma in children?

Answer 9

increase ICS to medium dose
or
add a 4th drug SR theophylline

Question 10

what is the step 6 treatment of asthma in children?

Answer 10

daily steroid tablets in lowest dose to control
maintain medium dose ICS
consider other treatments to minimise use of steroidal tablets

Question 11

are there any LAMAs in control of asthma in children?

Answer 11

no

Question 12

what are the ways that SABAs can be administered in children?

Answer 12

MDI with spacer or dry powder inhaler

Question 13

what are the adverse effects of ICSs?

Answer 13

height suppression
possible oral candidiasis
adrenocortical suppression
hypertension
cataracts

these side effects only common at high doses though

Question 14

what can LABAs not be used without?

Answer 14

ICS

Question 15

what is the LTRA used in children?

Answer 15

montelukast

Question 16

what are treatments used in step 6 to minimise the use of steroid tablets?

Answer 16

dealing with psychological issues
dealing with compliance issues
question the diagnosis
experimental medicine

Question 17

what are the important steps to take when using MDI?

Answer 17

shake inhaler
use a spacer
wash inhaler

Question 18

what are the non-pharmacological treatments of asthma in children?

Answer 18

stop tobacco smoke exposure

remove environmental triggers (eg. cat or dog)

Question 19

what signs are used to determine the severity of acute asthma?

Answer 19

Respiratory rate
Work of breathing
Heart rate
Oxygen saturations
Ability to complete sentences
Confusion
Air entry

Question 20

what is the treatment for mild acute asthma?

Answer 20

SABA via spacer

SABA via spacer and prednisolone

Question 21

what is the treatment for moderate acute asthma?

Answer 21

SABA via neb and prednisolone

SABA and ipratropium via nebuliser and prednisolone

Question 22

what is the treatment for severe acute asthma?

Answer 22

IV salbutamol
IV aminophylline
IV magnesium
IV hydrocortisone
intubate and ventilate

Question 23

what sort of steroids are used for acute asthma?

Answer 23

oral steroids

Question 24

what sort of steroids are used for chronic /maintenance of treatment?

Answer 24

inhaled steroids