Management of Asthma in children

Question 1

How steroid sensitive is childhood asthma?

Answer 1

very

Question 2

What should you use with MDIs (metered dose inhalers)?

Answer 2

spacers

Question 3

What are the goals of treating asthma?

Answer 3

minimal symptoms during day and night
minimal need for reliever medication
no attacks (exacerbations)
no limitation of physical activity

Question 4

When do you start start/restart treatment?

Answer 4

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

Question 5

Describe treatment decision hierarchy?

Answer 5

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?

Question 6

How do we measure control of asthma?

Answer 6

SANE
Short acting beta agonist/week
Absence school/nursery
Nocturnal symptoms/week
Exertional symptoms/week

Question 7

What are the things to think about if patient is completely controlled?

Answer 7

after 3 months with no treatment- reduce treatment

Question 8

What are the things to think about if patient is not completely controlled?

Answer 8

-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

Question 9

What is the first line treatment in all guide lines for asthma prevention?

Answer 9

low dose inhaled steroids
-2 puffs 2x a day

Question 10

What is the second line treatment for many guide lines?

Answer 10

have the addition of a long acting beta agonist- long acting reliever medication and that’s in combination with an inhaled steroid

Question 11

How is ART/MART ICS taken?

Answer 11

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)

Question 12

What type of medicine is the blue inhaler?

Answer 12

short acting beta agonist

Question 13

What are the medicines to treat asthma?

Answer 13

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

Question 14

Treatment overview of children? (order)

Answer 14

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

Question 15

What is different in treatment overview of adults?

Answer 15

First step is ART
Then MART (low dose)
Moderate dose MART
Check FeNO
LTRA or LAMA (Long acting muscarinic antagonist)

Question 16

What are the name of the steroid molecules in the brown inhalers?

Answer 16

Beclomethasone Budesonide
potency -1

Question 17

What is the name of the steroid molecule in the purple inhaler?

Answer 17

Fluticasone Diproprionate

Question 18

What are the adverse effects of inhaled steroids?

Answer 18

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

Question 19

What are the two rules of using a long acting beta agonist?

Answer 19

-do not use without an inhaled steroid
-used as a fixed dose inhaler

Question 20

Give characteristics of the leukotriene receptor antagonist?

Answer 20

Montelukast only
Rule of thirds
Better adherence
Nasty psychiatric side effects
Granules for reluctant toddlers

Question 21

Under fives treatment?

Answer 21

low dose inhaler steroid
if doesnt work
leukatrine receptor antagonist
Long acting beta agonists are not licensed for under 4s

Question 22

What are the three types of delivery systems?

Answer 22

MDI/ Spacer
Dry powder device
Breath actuated

Question 23

What ages can use dry powder devices?

Answer 23

licensed in over 5s , under 8s cannot use them

Question 24

Why should you use a spacer with an inhaler?

Answer 24

without spacer- 5% lung deposition
with spacer- 20% lung deposition

Question 25

Rules for using spacers?

Answer 25

shake before each squirt
wash- get 4 x out of it

Question 26

What improves asthma outcomes?

Answer 26

stop tobacco smoke exposure