Chronic Asthma: Children & Pregnancy Flashcards
1) What reliever therapy is prescribed to children and young people (aged 5 to 16) with newly diagnosed asthma?
2) when should children urgently have their asthma assessed?
1) SABA e.g. salbutamol
↳children with infrequent, short-lived wheeze and normal lung function, consider treatment with SABA reliever therapy alone
2) if using more than 1 SABA a month
what symptoms would indicate that treatment needs to be stepped up to maintenance therapy in children 5-16 (3)
Any 1 of the following:
1) Asthma-related symptoms 3 times a week or more
2) causing waking at night
3) Asthma that is uncontrolled with a SABA alone
↳ BTS/SIGN: Also asthma attack in the last 2 years
Outline the pharmacological treatment pathway for children and young people aged 5 to 16 according to NICE
Each step reviewed at 4 to 8 weeks
1) Intermittent reliever: SABA
2) Reg maintenance: Paediatric low dose ICS 1st line
3) Initial add-on: Paediatric Low dose ICS + LTRA
4) Additional add-on: If still uncontrolled stop LTRA and start LABA + paediatric low dose ICS
5) Change ICS and LABA to a MART regimen + paediatric low ICS dose (MART also used as reliever)
6) Increase ICS to a paediatric moderate dose (either as MART or change to fixed-dose of an ICS and a LABA, with a SABA as a reliever therapy).
7) Seeking advice and consider either:
↳ a) increasing the ICS to paediatric high dose (only as part of a fixed-dose regimen, with a SABA as reliever)
↳ b) trial of an additional drug (e.g. theophylline)
Outline the pharmacological treatment pathway for children and young people aged 5-12 according to BTS/SIGN
1) Intermittent reliever: SABA
2) Reg maintenance: very low dose ICS
↳ To be taken BD, consider total dose OD if controlled
3) Initial add-on: very low dose ICS + LABA OR LTRA
4) Additional add-on:
a) No response to LABA -stop LABA and increase ICS to low-dose
↳ If no response- Very low dose ICS + LTRA
b) If benefit from LABA but control still inadequate – continue LABA and increase ICS to low dose
↳ If ineffective - Very low dose ICS + LABA + LTRA or M/R (theophylline)
According to BTS/SIGN, if control remains inadequate on a combination of SABA PRN, a low dose ICS + an additional drug, usually a LABA, what interventions should be considered in children (5-12)
1) Increase ICS to medium-dose- pMDI + spacer should be used. or
2) LTRA or
3) M/R theophylline
4) Add tiotropium (12y+)
When does BTS/SIGN recommend adding a regular oral corticosteroid (prednisolone) to therapy?
Low dose prednisolone would be given in children with very severe asthma uncontrolled on a medium dose of ICS, and who have also tried (or are still receiving) a LABA, a LTRA, or M/R theophylline
what is the Intermittent reliever therapy recommended for children under 5?
Intermittent reliever: SABA as reliever therapy to children with suspected asthma. This should be used for symptom relief alongside all maintenance therapy
In the pharmacological treatment pathway for children under 5, regular maintenance therapy involves an 8-week trial of a pediatric moderate dose of ICS. After the 8 week trial the ICS is stopped. Explain how the following scenarios would be managed?
1) symptoms did not resolve during trial
2) symptoms resolved then reoccurred within 4 weeks
3) if symptoms resolved but reoccurred beyond 4 weeks
1) if symptoms did not resolve during the trial period, review whether an alternative diagnosis is likely
2) if symptoms resolved then reoccurred within 4 weeks- restart the ICS at a paediatric low dose as first-line maintenance therapy
3) Resolved but reoccurred beyond 4 weeks after stopping ICS treatment, repeat the 8-week trial of a paediatric moderate dose of ICS
Briefly outline the pharmacological treatment pathway for children under 5
1) Intermittent reliever: SABA
2) Reg maintenance: 8-week trial of a paediatric moderate dose of an ICS (and resultant action)
3) If still uncontrolled : paediatric low dose of ICS + LTRA
4) If suspected asthma is uncontrolled on paediatric low dose ICS + LTRA , stop the LTRA and refer to specialist
1) when should maintenance therapy be decreased in asthma patients?
2) how much should the dose be decreased by each time?
1) when patients asthma has been controlled with their current maintenance therapy for at least 3 months
2) Reductions should be considered every 3 months, decreasing the dose by 25-50% each time
what should be considered when deciding which drug to decrease first? (5)
1) severity of asthma
2) side effects of treatment
3) duration on current dose
4) beneficial effect achieved
5) patient preference
when would you consider stopping ICS treatment completely?
In people who are using pediatric or adult low dose ICS alone as maintenance therapy and are symptom-free
what is the drug of choice for exercise induced asthma?
SABA- used immediately before exercise
why is it important for asthma to be closely monitored and well controlled during pregnancy?
To reduce the risk of adverse maternal or fetal complications.
which drugs can be used as normal during pregnancy
1) SABA , LABAs, oral and inhaled corticosteroids, sodium cromoglicate and nedocromil , theophylline can be used as normal during pregnancy.
2) There is limited information on use of a LTRA but if required it should not be withed
