asthma management in children Flashcards
what is spontaneous resolution in asthma?
patient has asthma but “grows out of it”. asthma might return as an adult though
what are the goals for asthma treatment?
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)
what is the SANE mnemonic for measuring control of asthma in children?
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
if asthma is not well controlled what must be assessed before treatment is increased?
are they taking treatment?
are they taking treatment correctly?
do they have asthma?
when asthma is suspected what is the treatment to make the diagnosis?
very low to low dose ICS
what is the regular preventer management of asthma, step 2?
very low dose ICS or LTRA for <5years
what is the step 3 treatment for asthma in children?
very low dose ICS plus LABA for >/= 5years
or LTRA for <5years
what is the step 4 treatment for asthma in children?
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
what is the step 5 treatment of asthma in children?
increase ICS to medium dose
or
add a 4th drug SR theophylline
what is the step 6 treatment of asthma in children?
daily steroid tablets in lowest dose to control
maintain medium dose ICS
consider other treatments to minimise use of steroidal tablets
are there any LAMAs in control of asthma in children?
no
what are the ways that SABAs can be administered in children?
MDI with spacer or dry powder inhaler
what are the adverse effects of ICSs?
height suppression possible oral candidiasis adrenocortical suppression hypertension cataracts
these side effects only common at high doses though
what can LABAs not be used without?
ICS
what is the LTRA used in children?
montelukast
what are treatments used in step 6 to minimise the use of steroid tablets?
dealing with psychological issues
dealing with compliance issues
question the diagnosis
experimental medicine
what are the important steps to take when using MDI?
shake inhaler
use a spacer
wash inhaler
what are the non-pharmacological treatments of asthma in children?
stop tobacco smoke exposure
remove environmental triggers (eg. cat or dog)
what signs are used to determine the severity of acute asthma?
Respiratory rate Work of breathing Heart rate Oxygen saturations Ability to complete sentences Confusion Air entry
what is the treatment for mild acute asthma?
SABA via spacer
SABA via spacer and prednisolone
what is the treatment for moderate acute asthma?
SABA via neb and prednisolone
SABA and ipratropium via nebuliser and prednisolone
what is the treatment for severe acute asthma?
IV salbutamol IV aminophylline IV magnesium IV hydrocortisone intubate and ventilate
what sort of steroids are used for acute asthma?
oral steroids
what sort of steroids are used for chronic /maintenance of treatment?
inhaled steroids
