Asthma management of children Flashcards
what are the goals of treatment (5)
“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/or PEF >80% predicted or best)
how to measure how a child’s asthma is through history?
use SANE - closed questions
Short acting beta agonsit/week
Absence school/nursery
Nocturnal symptoms/week
Exertional symptoms/week
medications
Short acting beta agonists Inhaled corticosteroids (ICS)
then add:
Long acting beta agonists*
or oral steroids like Leukotriene receptor antagonist or Theophyllines
(if required)
why are corticosteroids good
they’re useful for diagnosis
very effective when taken
very safe (if prescribed correctly)
what are some adverse effects of inhaled corticosetroids in children?
height suppression
chance of oral candidiasis (oral thrush) if mouth isn’t washed after use
high dose therapies for children with asthma
Under 5s, refer for confirmation of diagnosis
Over 5s, increase to medium dose ICS and consider referral
what are the 4 groups of inhalers
Pressurised Metered Dose Inhaler
Pressurised Metered Dose Inhaler with a spacer
Breath actuated pressurised metered dose inhalers
Dry powder device
if there is a high probability from clinical investigation that a child has asthma what should be done?
trial of asthma treatment
if successful then continue minimum effective dose
if unsuccessful, assess inhaler technique/compliance
if no further improvement consider onward referral
if there is an intermediate probability from clinical investigation that a child has asthma what should be done?
consider lung function tests/atopy (genetic tendency to develop allergic diseases)
then move to high probability or low probability method from there
if there is a low probability from clinical investigation that a child has asthma what should be done?
consider referral
investigate/treat other cause
if no response to treatment, consider further investigation or onward referral
what action should be taken for a child under 5 with suspected asthma according to NICE
treat symptoms based on observation and clinical judgement, and review the child on a regular basis
If they still have symptoms when they reach 5 years, carry out objective tests
who can do peak flow test? and what is a positive result ie diagnosis of asthma
adults and children
over 20% variability in symptoms
