Chronic Asthma - Children

Question 1

For children, what is a common differential that has parents worried?

Answer 1

Viral induced wheeze
Bronchitis

Often child is well enough, sounds worse than it is as child has no social inhibition so cough’s away

Question 2

5 settings of asthma?

Answer 2

Infant
Childhood
Adult
Exertional
Occupational

Question 3

What does “sum of multiple hits” mean?

Answer 3

That coupling aetiological factors will get you to asthma, which is why patients from different backgrounds get it as they have more aspects of one factor than another

Genetic
Abnormal lungs
Early onset atopy
Enviroment

Question 4

Treatment in childen, NICE guidelines step 1 and 2?

Answer 4

Remember always give a reliever for emergencies

Step 1 - Monitored initiation of very low/peads - a low ICS dose to confirm a diagnosis

Step 2 - Once asthma is con firmed start with a very low peads dose of ICS

Question 5

Step 3?

Answer 5

If over 5 - Add LABA

If under 5 - Add LTRA

Question 6

Step 4?

Answer 6

If no effect from the LABA remove and up the ICS to a low dose

If LABA effect, keep it and up ICS dose to low

If control bad from LABA and an upped ICS low dose - add LTRA

Question 7

Step 5?

Answer 7

Consider trials of medium ICS dose

Consider adding SR Theophylline

Question 8

Step 6?

Answer 8

Daily steroid tablets in lowest dose possible

Maintain medium ICS

Look for ways to get off oral steroids

Question 9

Adverse effects of ICS in kids?

Answer 9

Reduced height
Oral candidasis
Adrenocorticol supression