Management of Asthma - Children

Question 1

What are the goals of asthma treatment?

Answer 1

• “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)

Question 2

How to measure control of asthma?

Answer 2

• Closed questions
• SANE
• Short acting beta agonist/week
• Absence school/nursery
• Nocturnal symptoms/week
• Excertional symptoms/week

Question 3

What is the step up step down approach?

Answer 3

• Started on low dose ICS
  
  • Severe may respond to minimal treatment
• Review after 2mo
  
  • No routine test to monitor progress (?)
  • No change easier than down
  • Need an inhaler holiday (Easter)

Question 4

Classification of medications for asthma

Answer 4

• Short acting beta agonists
• Inhaled corticosteroids (ICS)
• Long acting beta agonists*
• Leukotriene receptor antagonists*
• Theophyllines*
• Oral steroids
• “add ons”

Question 5

Name a very safe, very effective medication for children with asthma

Answer 5

INHALED CORTICOSTEROIDS

Question 6

Adverse effects of ICS

Answer 6

Height suppression
? Oral candidiasis
? Adrenocortical suppression*

X Hypertension
X Cataracts
*Particularly with fluticasone
Go brown!

Question 7

LONG ACTING BETA AGONIST

Answer 7

Only 2 things to remember!

• Do not use without ICS
• Use as fixed dose inhaler

Question 8

LEUKOTRIENE RECEPTOR ANTAGONIST

Answer 8

• Montelukast only
• Rule of thirds
• Better adherence
• Granules for reluctant toddlers

Question 9

INITIAL ADD ON PREVENTER (STEP 3)

Answer 9

• Add on LABA or LTRA (BTS/SIGN)
• Add on LTRA (NICE)
• Increase ICS dose (GINA)

Question 10

Delivery systems

Answer 10

• Two types
  
  • MDI/spacer
  • Dry powder device

Question 11

Dry powder device

Answer 11

Licensed in over 5s, under 8s cannot use them
Achieve 20% lung deposition

Question 12

NEBULISERS

Answer 12

• Not indicated for day-to-day use
• MDI spacer vs nebuliser
  ~ Quieter
  ~ Quicker
  ~ Valve mechanism
  ~ Don’t break down
  ~ Portable
  ~ Cheaper

Question 13

Other managements of asthma

Answer 13

Stop tobacco smoke exposure
Remove environmental triggers
- Cat, Dog
- HDM??

Question 14

How do you choose what medication to give asthma patients

Answer 14

Look at the patient
- Respiratory rate
- Work of breathing
- Heart rate
- Oxygen saturations
- Ability to complete sentences
- Confusion
- Air entry