Asthma Management in Children (Non-Acute) Flashcards
What details about asthma treatment are important?
There is no cure for asthma, only palliation and spontaneous resolution.
The QoL of the patient should be considered first and foremost.
What are the goals of asthma treatment?
Minimal symptoms and need for reliever medication (less than 2 days a week).
No attacks, exacerbations, or limitations of physical activity.
How do you measure control of asthma?
Use closed questions and SANE:
SABA/week.
Absences from school.
Nocturnal symptoms/week.
Exertional symptoms/week.
What are the variables of asthma treatment?
Are symptoms really controlled?
Is treatment already being taken?
Will this treatment change actually help?
What are some considerations if asthma is well controlled?
No change?
Reduce?
What are some considerations if asthma is not well controlled?
Not taking treatment (correctly) - no change.
Not asthma - stop asthma Rx.
None of the above - increase Rx.
What is the step up step down approach?
Low dose ICS.
Regular preventer (or LTRA for <5yrs).
Initial add-on preventer (ICS and LABA / LTRA).
Additional add-ons.
Anything further - refer to a specialist.
What are the different additional add-ons?
No response to LABA - stop LABA, increase ICS dose.
Benefit from LABA, but control is still poor - continue LABA and increase ICS dose.
Compare adult asthma therapy to child asthma therapy.
Adults have -
A max ICS dose of 800 micrograms.
No oral B2 tablets or LAMA.
ICS as the first line preventer.
When are regular preventers used?
If using a blue inhaler / B2 agonists more than 2 days a week.
If symptomatic 3 times a week or more.
If waking 1 night a week.
LTRA for <5yrs.
What can oral steroids cause?
Hypertension.
Cataracts.
How should LABA be used?
With ICS.
As a fixed dose inhaler.
How are LTRA given?
1/3 of individuals get a small benefit.
Better adherent to oral medications.
Tablets or granules for reluctant toddlers.
What medications should you give to an asthma patient who is poorly controlled?
LABA + ICS.
LTRA and increasing ICS dose can be considered.
What are the two forms of severe asthma?
Resistant to treatment (a minority).
‘Troublesome’ - due to psychological or compliance issues.
Do they have asthma?
Are they taking the treatment?
If not, why are they not taking the treatment?
