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Year 1- Respiratory > Management of Asthma in Children > Flashcards

Management of Asthma in Children Flashcards

1
Q

What are the main goals in the treatment of asthma?

A

Minimal symptoms in day/night
Minimal need for reliever medication (inhalers etc.)
No attacks/exacerbations
No limitation to physical activity

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2
Q

What is the aim in terms of reducing the need for releiver treatmment?

A

Reduce it so that it is only required at a maximum of two days/week.

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3
Q

What type og questions are best when trying to measure control?

A

Closed questions

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4
Q

Describe the questions asked when measuring control assisted my the mnemonic SANE.

A

Short acting beat agonist / week (using blue inhaler more than 2x per week).
Absence from school or nursery
Nocturnal symptoms/.week
Exertional symptoms/week

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5
Q

In terms of nocturnal symptoms, how many times should a person with controlled asthma be waking up?

A

Preferably none but no more than once a week

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6
Q

In the same way as if you were monitoring hypertension, you’d look at blood pressure, or if you were measuring diabetes, you’d look at blood glucose, how do you monitor asthma?

A

Looking at symptoms

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7
Q

What should we do if asthma is well controlled in the patient?

A

Do nothing or reduce treatment

(if patient has been completely symptom free for three months, you might consider stepping the treatment down as a rule of thumb but every case is different).

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8
Q

If the asthma in the patient is not well controlled, what considerations need to be made?

A

If they are taking the medication/taking i correctly
If they don’t have asthma

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9
Q

What can you do if the patient isn’t taking the treatment or not taking it correctly?

A

Sit down with them to expalin why and how to use it.

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10
Q

What do you do if the patient doesn’t have asthma?

A

Stop treatment

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11
Q

Describe the dosage patients with suspected asthma are given.

A

Low dose of inhaled steroids as even those with severe asthma will respond to low doses

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12
Q

After starting a patient on low inhaled steroids, how long until you should review them

A

Approx. 2 months

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13
Q

Why is the holiday break away from asthma around Easter and known as the ‘Easter holiday’?

A

Coughs and colds are less common around the Easter and will be less likely to have an asthma attack

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14
Q

What is the main purpose of the blue inhaler?

A

Reliever

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15
Q

What is the function of the brown inhaler?

A

Reduces symptoms

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16
Q

What type of medication is in the blue inhaler?

A

Short acting beta agonists

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17
Q

List some of the medications given to children with asthma.

A

Inhaled Corticosteroids (ICS)
Long acting beta agonists (add on)
Leukotriene receptor antagonists (add on)
Theophylline (add on)
Oral steroids

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18
Q

What is the maximum dose of inhaled corticosteroids in those under the age of 12?

A

800mg

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19
Q

What is the first line preventer treatment in chidlren?

A

inhaled steroids or leukotriene receptor antagonists.

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20
Q

What is the first line prevention treatment in adults?

A

Inhaled steroids

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21
Q

Describe poorly controlled patients.

A

Using blue inhaler > 2x/week
Symptomatic > 3x/week
Waking up once or more/week

22
Q

For ICS, which dose in most effective?

A

Low to medium doses
Do not get double the response when doubling the drug

23
Q

What is a disadvantage of high doses of ICS?

A

More adverse effects

24
Q

What can oral steroids cause?

A

High blood pressure and cataracts

25
Q

What do you need to remember when adding long acting beta agonists to treatment plans?

A

Do not use without ICS
Use as a fixed dose inhaler

26
Q

Describe leukotriene receptor antagonist treatment

A

One third of population have big benefit, one third has slight, one third have no.
Tablet form but granules for toddlers

27
Q

What should be added to inhaled steroids if a patient is poorly controlled?

A

Add on long acting beta agonist but keep an open mind

28
Q

In children 5 and under, which add on should be given if their asthma is poorly controlled?

A

Inhaled LABA (long acting beta agonists)

29
Q

In children over5, which add on should be given if their asthma is poorly controlled?

A

Add LTRA (Leukotriene receptor antagonists)

30
Q

If there is no response to LABA, what should you do?

A

Stop LABA and increase to low dose of ICS

31
Q

What should you do if there is some improvement from LABA but still inadequate control?

A

Continue LABA and increase to low dose of ICS

32
Q

What should you do if your patient is a child and might need high dose therapies or oral steroids?

A

Refer to asthma specialist

33
Q

What are the two types of delivery systems of treatment?

A

Metered dose inhaler w a spacer
Dry powder device

34
Q

What is the lung disposition of the inhaler without a spacer?

A

<5%

35
Q

What is the lung disposition of the inhaler with a spacer?

A

> 20%

36
Q

What should you do to the inhaler between puffs?

A

Shake the inhaler

37
Q

What is something you must do with a spacer?

A

Wash it monthly!

38
Q

What does washing the spacer do?

A

Reduces static

39
Q

Who cannot use dry power devices?

A

Those under eight unless over five and liscensed.

40
Q

What is the lung disposition of dry power devices?

A

Approx. 20%

41
Q

List the advantages of a MDI spacer compared to a nebuliser.

A

Quieter
Quicker
Potable
Cheaper
Valve mechanism
Don’t break down

42
Q

What are the environmental factors which can improve a child’s asthma?

A

Less exposure to tobacco
Remove triggers like a cat or dog if they cause symtoms

43
Q

What treatment is best for children with mild acute asthma?

A

Short acting bronchodilators (SABA) via spacer

44
Q

What treatment is best for children with moderate acute asthma?

A

SABA
Oral prednisolone

45
Q

When are nebulisers useful?

A

In children with moderate serve asthma

46
Q

What type of treatment is often given to those with severe asthma?

A

IV meds

47
Q

In acute asthma, how long do you wait before reviewing a patient after starting them on treatment?

A

An hour

48
Q

What are the chronic/maintenance treatments?

A

Inhaled steroids

49
Q

What are the acute treatments?

A

Oral steroids

50
Q

In acute asthma, what is the level of treatment required assessed by?

A

Respiratory rate
Work of breathing
Heart rate
Oxygen sat
Ability to complete sentences
Confusion (often due to hypoxia)
Air entry

51
Q

What can be useful to follow in terms of guiding treatment?

A

Oxygen saturation
Oxygen requirement

Year 1- Respiratory (36 decks)

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