Management of Asthma in Children Flashcards
What are the main goals in the treatment of asthma?
Minimal symptoms in day/night
Minimal need for reliever medication (inhalers etc.)
No attacks/exacerbations
No limitation to physical activity
What is the aim in terms of reducing the need for releiver treatmment?
Reduce it so that it is only required at a maximum of two days/week.
What type og questions are best when trying to measure control?
Closed questions
Describe the questions asked when measuring control assisted my the mnemonic SANE.
Short acting beat agonist / week (using blue inhaler more than 2x per week).
Absence from school or nursery
Nocturnal symptoms/.week
Exertional symptoms/week
In terms of nocturnal symptoms, how many times should a person with controlled asthma be waking up?
Preferably none but no more than once a week
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?
Looking at symptoms
What should we do if asthma is well controlled in the patient?
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).
If the asthma in the patient is not well controlled, what considerations need to be made?
If they are taking the medication/taking i correctly
If they don’t have asthma
What can you do if the patient isn’t taking the treatment or not taking it correctly?
Sit down with them to expalin why and how to use it.
What do you do if the patient doesn’t have asthma?
Stop treatment
Describe the dosage patients with suspected asthma are given.
Low dose of inhaled steroids as even those with severe asthma will respond to low doses
After starting a patient on low inhaled steroids, how long until you should review them
Approx. 2 months
Why is the holiday break away from asthma around Easter and known as the ‘Easter holiday’?
Coughs and colds are less common around the Easter and will be less likely to have an asthma attack
What is the main purpose of the blue inhaler?
Reliever
What is the function of the brown inhaler?
Reduces symptoms
What type of medication is in the blue inhaler?
Short acting beta agonists
List some of the medications given to children with asthma.
Inhaled Corticosteroids (ICS)
Long acting beta agonists (add on)
Leukotriene receptor antagonists (add on)
Theophylline (add on)
Oral steroids
What is the maximum dose of inhaled corticosteroids in those under the age of 12?
800mg
What is the first line preventer treatment in chidlren?
inhaled steroids or leukotriene receptor antagonists.
What is the first line prevention treatment in adults?
Inhaled steroids
Describe poorly controlled patients.
Using blue inhaler > 2x/week
Symptomatic > 3x/week
Waking up once or more/week
For ICS, which dose in most effective?
Low to medium doses
Do not get double the response when doubling the drug
What is a disadvantage of high doses of ICS?
More adverse effects
What can oral steroids cause?
High blood pressure and cataracts
What do you need to remember when adding long acting beta agonists to treatment plans?
Do not use without ICS
Use as a fixed dose inhaler
Describe leukotriene receptor antagonist treatment
One third of population have big benefit, one third has slight, one third have no.
Tablet form but granules for toddlers
What should be added to inhaled steroids if a patient is poorly controlled?
Add on long acting beta agonist but keep an open mind
In children 5 and under, which add on should be given if their asthma is poorly controlled?
Inhaled LABA (long acting beta agonists)
In children over5, which add on should be given if their asthma is poorly controlled?
Add LTRA (Leukotriene receptor antagonists)
If there is no response to LABA, what should you do?
Stop LABA and increase to low dose of ICS
What should you do if there is some improvement from LABA but still inadequate control?
Continue LABA and increase to low dose of ICS
What should you do if your patient is a child and might need high dose therapies or oral steroids?
Refer to asthma specialist
What are the two types of delivery systems of treatment?
Metered dose inhaler w a spacer
Dry powder device
What is the lung disposition of the inhaler without a spacer?
<5%
What is the lung disposition of the inhaler with a spacer?
> 20%
What should you do to the inhaler between puffs?
Shake the inhaler
What is something you must do with a spacer?
Wash it monthly!
What does washing the spacer do?
Reduces static
Who cannot use dry power devices?
Those under eight unless over five and liscensed.
What is the lung disposition of dry power devices?
Approx. 20%
List the advantages of a MDI spacer compared to a nebuliser.
Quieter
Quicker
Potable
Cheaper
Valve mechanism
Don’t break down
What are the environmental factors which can improve a child’s asthma?
Less exposure to tobacco
Remove triggers like a cat or dog if they cause symtoms
What treatment is best for children with mild acute asthma?
Short acting bronchodilators (SABA) via spacer
What treatment is best for children with moderate acute asthma?
SABA
Oral prednisolone
When are nebulisers useful?
In children with moderate serve asthma
What type of treatment is often given to those with severe asthma?
IV meds
In acute asthma, how long do you wait before reviewing a patient after starting them on treatment?
An hour
What are the chronic/maintenance treatments?
Inhaled steroids
What are the acute treatments?
Oral steroids
In acute asthma, what is the level of treatment required assessed by?
Respiratory rate
Work of breathing
Heart rate
Oxygen sat
Ability to complete sentences
Confusion (often due to hypoxia)
Air entry
What can be useful to follow in terms of guiding treatment?
Oxygen saturation
Oxygen requirement
