Management of asthma adults and children Flashcards
What are symptoms of asthma?
- Shortness of breath
- Wheeze
- Cough
- Chest tightness
- Diurnal variability
- Episodic
- Atopy
What are signs of asthma?
- Wheeze on auscultation
- Eczema
- Obstructed spirometry
- Peak expiratory flow (PEF) changes
- Response to treatment
What are the aims of treatment of asthma?
- No daytime symtoms
- No need for rescue medication
- No asthma attacks
- Minimal side effects from medication
- No limitations on activity including exercise & normal lung function (in practical terms FEV1 and/or PEF>80% predicted or best)
What are non pharmacological management methods of asthma?
- Exercise
- Smoking cessation
- Weight management
- Flu/pneumococcal vaccinations
- Patient education and self management plans
Pharmacological managements of asthma
- Inhaled therapy
- Oral therapy
- Specialist treatments
How do you evaulate and assess someone with asthma?
- Assess symptoms
- Measure lung function
- Check inhaler technique and adherence
- Adjust dose
- Update self-management plans
- Move up and down plan as appropriate
What are inhalers?
- Small dose of drugs
- Delivery directly to the target organ (airways and lung)
- Onset of effect is faster
- Minimal systemic exposure
- Systemic adverse effects are less severe and less frequent
Types of inhalers
- pMDI (metered dose inhalers)
- pMDI with spacers
- Dry powder inhalers (DPI)
- Short acting B2 agonists (SABA)-relievers
Types of Short acting B2 agonists (SABA)
- Salbutamol: MDI, DPI
- Terbutaline: DPI
Examples of oral therapy for asthma
- Leukotriene receptor antagonist
- Theophylline
- Prednisolone
Specialist options for treatment of asthma
- Omalizumab (Anti- IgE)
- Mepolizumab (anti-interleukin-5)
- Bronchial thermoplasty
What to do for a mild acute asthma attack?
- Increase inhaler use
- Oral steroid
- Treat trigger
- Early follow up
- Back up plan
What to do for a moderate-severe acute asthma attack?
- Nebulisers: salbutamol/Ipatropium
- Oral/IV steroid
- Magnesium
- Aminophylline
- Triggers: infection/allergen
- Complications: CXR
- Review
- Level 2/3 care
Contrasts of asthma with COPD
- Age of onset
- Smoking history
- Response to treatment
- Treatment goals
- Trajectory
Similarities of asthma with COPD
- Similar therapies
- Non-pharmacological interventions same
How to measure control of asthma in children?
- Closed questions
- SANE:
- Short acting beta agonist/week
- Absence school/nursery
- Nocturnal symptoms/week
- Excertional symptoms/week
What is the step up step down approach?
Start on low dose ICS - Severe may respond to minimal treatment Review after 2 months - No routine test to monitor progress - Stepping up easier than down
What are the different classes of medications for asthma?
- Short acting beta agonists
- Inhaled corticosteroids (ICS)
- Long acting beta agonists*
- Leukotriene receptor antagonists*
- Theophyllines*
- Oral steroids#
- = add ons
What is the contrast of children’s asthma treatment compared to adults?
- Max dose ICS 800 microg (<12 yo)
- no oral B2 tablet
- LTRA first line preventer in <5s
- No LAMAs
- Only two biologicals
How should you use long acting beta agonist?
- Do not use without inhaled corticosteroids
- Use as fixed dose inhaler
Features of leukotriene receptor antagonist
- Montelukast only
- Rule of thirds
- Better adherence
- Granules for reluctant toddlers
High dose therapies for under 5s and over 5s
- Under 5s, refer for confirmation of diagnosis
- Over 5s, increase to medium dose ICS and consider referral
What are the 2 types of delivery systems for children?
- MDI/spacer
- Dry powder device: under 8s cannot use them
MDI spacer compared to nebuliser
- Quieter
- Quicker
- Valve mechanism
- Don’t break down
- Portable
- Cheaper
Confirmed other management methods to improve asthma
- Stop tobacco smoke exposure
- Remove environmental triggers: Cat, Dog
What do you use to treat mild acute asthma in children?
- SABA via spacer
- SABA via spacer + pred
What do you use to treat moderate acute asthma in children?
- SABA via neb + pred
- SABA + ipra via neb + pred
What do you use to treat serious acute asthma in children?
- IV salbutamol
- IV aminophylline
- IV magnesium (neb)
- IV hydrocortisone
- Intubate and ventilate
How do you choose what treatment to use for acute asthma in children?
Look at the patient
- Respiratory rate
- Work of breathing
- Heart rate
- Oxygen saturations
- Ability to complete sentences
- Confusion
- Air entry
In what treatments do you use inhaled steroids and oral steroids?
- Chronic/maintenance treatment = inhaled steroids (not oral steroids)
- Acute treatment = oral steroids (not inhaled steroids)
Quote to remember
No wheeze, No asthma
