Asthma Management in Children

Question 1

What is the most important thing to remember when diagnosing asthma?

Answer 1

No wheeze, no asthma

Question 2

What can you say about a cure for asthma?

Answer 2

There is no cure, only palliation or spontaneous resolution

Question 3

What are the goals of asthma treatment?

Answer 3

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%)

Question 4

What is the acronym for measuring the control of asthma?

Answer 4

SANE

Short acting beta agonist/week

Absence from school

Nocturnal symptoms/week

Exertional symptoms/week

Question 5

What must be asked when deciding to treat if the asthma is well controlled?

Answer 5

No change?

Reduce?

Question 6

What must be asked when deciding to treat when symptoms are not well controlled?

Answer 6

Not taking the treatment? (no change)

Not taking treatment correctly? (no change)

Not asthma? (stop asthma treatment)

None of the above? (increase treatment)

Question 7

What is the step up and step down approach?

Answer 7

Start on a low dose

Review after 2 months

Question 8

Why do you start on a low dose and increase after reviews?

Answer 8

Severe may respond to minimal treatment

It is easier to step up than down

Question 9

What are some different classes of asthma medicine?

Answer 9

Short acting beta agonist

Inhaled corticosteroids (ICS)

Long acting beta agonist

Leukotriene receptor antagonist

Theophylline

Oral steroids

Question 10

What does ICS stand up for?

Answer 10

Inhaled corticosteroids

Question 11

What should you remember about the guidelines for the treatment of asthma from country to country?

Answer 11

They may change

Question 12

What are contrasts between childrens medication and adults?

Answer 12

Max dose ICS 800mg

No oral B₂ tablet

LTRA first line prevent in <5s

No LAMAs

Question 13

What is the max dose of ICS for children?

Answer 13

800mg

Question 14

What does LAMA stand up for?

Answer 14

Long acting muscarinic antagonist

Question 15

When should you use a regular inhaler?

Answer 15

B₂ agonist > 2 times per week

Symptomatic 3 times a week or more, or waking one night a week

Question 16

What should be used as a regular inhaler if required?

Answer 16

Very low dose corticosteroids (or LTRA in <5s)

Question 17

What does LTRA stand up for?

Answer 17

Leukotreine receptor antagonist

Question 18

What are advantages of inhaled corticosteroids?

Answer 18

Very useful for diagnosis

Very effective

Very safe

Question 19

What should be remembered about increasing the dose of ICS?

Answer 19

Positive effects plateua while adverse effects increase

Question 20

What are some adverse effects of ICS?

Answer 20

Height suppresion

Oral candidiasis

Adrenocortical suppresion

Hypertension

Cataracts

Question 21

What could be used as additional add on preventors?

Answer 21

LABA or LTRA

LTRA

Increase ICS dose

Question 22

What 2 things should be remembered about long acting beta agonists (LABA)?

Answer 22

Do not use without ICS

Use as a fixed dose inhaler

Question 23

What is the drug used as a leukotriene receptor antagonist?

Answer 23

Montelukast

Question 24

What is montelukast?

Answer 24

Leukotriene receptor antagonist

Question 25

What are advantages of leukotriene receptor antagonists?

Answer 25

Better adherance Granules for reluctant toddlers

Question 26

What are high dose therpies used for in under 5s?

Answer 26

Confirmation of diagnosis

Question 27

What should you do if a high dose therapy is required for over 5s?

Answer 27

Increase to medium dose ICS and consider referral

Question 28

What should be done if no changes to asthma treatment allows the control of the asthma?

Answer 28

Experimental medicine 50% psychological issues \>50% compliance issues Question the diagnosis Minority with genuine severe disease

Question 29

What are the 2 kinds of delivery systems?

Answer 29

MDI/spacer Dry powder device (DPD)

Question 30

What should be remembered about children compared to adults?

Answer 30

They are less compliant

Question 31

How should inhalers be used?

Answer 31

Shake inhaler between puffs Eash spacer monthly to reduce static Each of these things increases delivery by 100%

Question 32

What should you do to the inhaler between puffs?

Answer 32

Shake it

Question 33

How often should the inhaler be washes?

Answer 33

Once per month

Question 34

What does washing the inhaler and shaking it increase delivery by?

Answer 34

100%

Question 35

How does using a spacer increase delivery?

Answer 35

4x medicine goes to the lungs than had you not used it

Question 36

How much of a drug reaches the lungs when the inhaler is used with a not tightly fitted face mask?

Answer 36

0.1%

Question 37

How much of the drug reaches the lungs when the child is crying?

Answer 37

1%

Question 38

How much of the drug reaches the lungs when the child is quietly inhaling?

Answer 38

8%

Question 39

What age is allowed to use dry powdered devices?

Answer 39

Licensed in over 5s (but under 8s cannot use them)

Question 40

What lung deposition does dry powder devices achieve?

Answer 40

20%

Question 41

Why is an MDI spacer better than a nebuliser?

Answer 41

Quieter Quicker Valve mechanism Don't break down Portable Cheaper

Question 42

What are some non-medical interventions?

Answer 42

Stop tobacco smoke exposure Remove environmental triggers

Question 43

What are some non-medical interventions that people believe, but are not proven by clinical evidence?

Answer 43

Diet Alter humidity Weight reduction

Question 44

What needs to be considered when deciding which medication to use?

Answer 44

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

Question 45

What medicine should be used for mild severity?

Answer 45

SABA with spacer

Question 46

What medicine should be used for moderate severity?

Answer 46

SABA with nebuliser

Question 47

What medicine should be used for severe severity?

Answer 47

IV salbutamol IV aminophylline IV magnesium IV hydrocortisone

Question 48

What should you do for acute asthma reactions?

Answer 48

Start treatment and reassess in 1 hour Step up or down as appropriate

Question 49

What kind of steroids should be used for chronic/maintanence treatment?

Answer 49

Inhaled steroids

Question 50

What kinds of steroids should be used for acute treatment?

Answer 50

Oral steroids

Question 51

What does SIGN stand up for?

Answer 51

Scottish Intercollegiate Guidelines Network

Question 52

What does BTSG stand up for?

Answer 52

British Thoracic Society Guidelines

Question 53

What approach does SIGN and BTSG use to asthma treatment?

Answer 53

Stepwise approach

Question 54

What is step 1 to 5 of asthma treatment?

Answer 54

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