Management of Asthma in children Flashcards
How steroid sensitive is childhood asthma?
very
What should you use with MDIs (metered dose inhalers)?
spacers
What are the goals of treating asthma?
minimal symptoms during day and night
minimal need for reliever medication
no attacks (exacerbations)
no limitation of physical activity
When do you start start/restart treatment?
as part of a diagnosis
if needing blue inhaler for more than 2 days a week- need to be on a preventer
coughing and waking at least one time a week- need to be on preventer
having 1 or 2 admissions in the last 12 months
Describe treatment decision hierarchy?
Are the patient’s symptoms fully/partly/not controlled?
Are they taking their treatment (correctly)?
Have they had an attack recently?
How often are they using their reliever treatment?
What is their current treatment level?
How do we measure control of asthma?
SANE
Short acting beta agonist/week
Absence school/nursery
Nocturnal symptoms/week
Exertional symptoms/week
What are the things to think about if patient is completely controlled?
after 3 months with no treatment- reduce treatment
What are the things to think about if patient is not completely controlled?
-not taking treatment?
-not taking treatment correctly? - no change to asthma prescription
not asthma possibly (taking treatment but symptoms are just as bad) and therefore stop asthma prescription
what if none of the above - increase the treatment
What is the first line treatment in all guide lines for asthma prevention?
low dose inhaled steroids
-2 puffs 2x a day
What is the second line treatment for many guide lines?
have the addition of a long acting beta agonist- long acting reliever medication and that’s in combination with an inhaled steroid
How is ART/MART ICS taken?
ART (As Required Therpay)
people aged 12 and above if ICS dont work- take away brown inhaler and blue reliever and give ART/MART ICS when have symptoms.
Take in morning (like brown) and evening and also take when required (like blue)
What type of medicine is the blue inhaler?
short acting beta agonist
What are the medicines to treat asthma?
Short acting beta agonists
Inhaled corticosteroids (ICS)
Long acting beta agonists*
Leukotriene receptor antagonists*
Theophyllines*
Oral steroids
* “add ons”
Treatment overview of children? (order)
Start low dose ICS bd
MART, based on one study, what is low/moderate dose MART?
“no asthma inhalers licenced”
Not manage MART
Add LTRA (Leukotriene receptor antagonists)
Add LABA (Long-acting beta-agonists)
Moderate dose
What is different in treatment overview of adults?
First step is ART
Then MART (low dose)
Moderate dose MART
Check FeNO
LTRA or LAMA (Long acting muscarinic antagonist)
What are the name of the steroid molecules in the brown inhalers?
Beclomethasone Budesonide
potency -1
What is the name of the steroid molecule in the purple inhaler?
Fluticasone Diproprionate
What are the adverse effects of inhaled steroids?
If give inhaled steroids at recommended dose from the age of four through to 11- their final adult height is reduced by between a half and one cm
possible oral candidiasis
?adrenocortical suppression- if on more potent steroids there may be suppression of own steroids
What are the two rules of using a long acting beta agonist?
-do not use without an inhaled steroid
-used as a fixed dose inhaler
Give characteristics of the leukotriene receptor antagonist?
Montelukast only
Rule of thirds
Better adherence
Nasty psychiatric side effects
Granules for reluctant toddlers
Under fives treatment?
low dose inhaler steroid
if doesnt work
leukatrine receptor antagonist
Long acting beta agonists are not licensed for under 4s
What are the three types of delivery systems?
MDI/ Spacer
Dry powder device
Breath actuated
What ages can use dry powder devices?
licensed in over 5s , under 8s cannot use them
Why should you use a spacer with an inhaler?
without spacer- 5% lung deposition
with spacer- 20% lung deposition
Rules for using spacers?
shake before each squirt
wash- get 4 x out of it
What improves asthma outcomes?
stop tobacco smoke exposure
When do you give steroids orally and inhaled?
chronic/ maitenance treatment= inhaled steroids
acute treatment= oral steroids
