Management of Asthma in Children Flashcards
What are the main goals of asthma treatment?
Minimal symptoms during the day and night
Minimal need for reliever medication
No attacks (exacerbations)
No limitation of physical activity
(normal lung function, FEV1 & PEFR > 80% predicted / best)
What questions should be asked to decipher how well controlled a patients asthma is?
Mnemonic - SANE:
- Short acting beta agonist use per week?
- Absences at school due to condition
- Nocturnal symptoms experienced per week?
- Excertional symptoms per week?
How many times is the upper limit for an asthma patient using their SABA per week?
2 times
If they are using their blue inhaler more than 2 times per week they are poorly controlled
How often should a well controlled asthma patient be experiencing nocturnal and excertional symptoms per week?
They shouldn’t
Experiencing these symptoms indicated poor control
If an asthma patient has been well controlled for more than 3 months, what should be considered?
Stepping down their treatment
Might not be needing treatment to the extent they’re recieving it
What is the first step in asthma management?
2 months of low dose inhaled ICS. Always first step bc part of the diagnostic process
Review effect after 2 months
(Need to take a break from the inhaler to make sure it’s actually asthma, usually done around easter bc low chance of infection & exacerbation)
What classes of medications are available for the treatment of paediatric asthma?
Short acting beta agonists (SABA) Inhaled corticosteroids Long acting beta agonists (LABA) Leukotriene receptor antagonists Theophyllines Oral steroids
What is the first line treatment for paediatric asthma in the stepwise progression?
Inhaled corticosteroids for children > 5yrs
Leukotriene receptor agonists for children under 5 years of age
What is the maximum dose of ICS in children?
800 microg
What symptoms would indicate a trial of ICS should be started? (or LRTA’s in under 5s)
- Symptomatic 3 or more times per week (need blue inhaler)
- waking 1 or more nights per week
What is one possible side effect of using too high a dosage of ICS?
Adrenocortical suppression
What are 2 things to remember when it comes to using long acting beta agonists?
Don’t use without ICS
Give them in a fixed dose inhaler
How do kids tend to respond to treatment with LRTA’s? What is one advantage of them?
Rule of thirds (1/3 good response, 1/3 some response, 1/3 no response)
Better adherence due to tablet / granule form
What is the second step in asthma treatment? (already on ICS)
Add on a LABA
This doesn’t work best for everyone though and response in some individuals is better with:
- LTRA added on
- Increased ICS dose
What are the two types of severe asthma?
- Treatment resistant asthma (very rare in paeds)
- Troublesome asthma (the patient says they’re taking the treatment, but they aren’t taking the treatment - may have psychological / domestic issues)
If a patient has severe treatment resistant asthma what class of drugs is available?
Biologics
omalizumab / Mepolizumab
What is one group of asthma treatment medications that is not available for chilfdren?
LAMA’s
What are the two types of delivery systems for asthma medications?
Meter dosed inhaler +spacer (can use without spacer but you get less than 5% of the medication in your lungs compared to 20% with spacer)
Dry powder device
What are two important things to remember when using inhalers with spacers?
Shake the inhaler before using
Wash the spacer monthly with detergent
Which medication delivery devices are used by children of different ages?
under 8s - MDI + spacer
Boys 8-11 - MDI + spacer
Girls 8-11 - dry powder device
12+ - MDI
When are nebulisers used? What is a nebuliser?
Not usually
Maybe if the person is unconscious, but they have low drug deposition and intrinsic mechanics break down more often so not much upside
Basically an oxygen mask but spits out meds instead
What are some non-pharmacological methods of improving childs asthma?
Stop smoking (usually directed at parents)
Removing environmental triggers (such as cats if they trigger the child - if they don’t trigger them then they’re chill)
What medication would be given to a child that is suffering a mild asthma attack?
SABA via a spacer
Or if more severe:
SABA via a spacer + prednisolone
What medication would be given to a child that is suffering a moderate asthma attack?
SABA via a spacer + prednisolone
Or if more severe:
SABA via spacer + ipratropium bromide via nebuliser + prednisolone
What does ipratropium bromide do?
Bronchodilator
For children experiencing severe asthma attacks, what treatment options are available?
- IV salbutamol
- IV aminophylline
- IV magnesium
- IV hydrocortisone
- Intubation and ventilation
If a patient presents to the hospital having an asthma attack and seems very agitated or otherwise strange, what may they be suffering from?
Hypoxia causing confusion
What are some of the factors that you need to pay close attention to when first examining the patient presenting with an acute asthma attack?
Resp and heart rate Work of breathing Oxygen saturation Ability to speak (complete sentences without breathing?) Confusion Air entry
Presence of symptoms indicates severity and therefore treatment
What signs are seen when a child is having a respiratory attack?
Stomach bulging in and out (due to force of diaphragmatic contractions)
Contraction of the intercostal muscles
Tracheal tug
What is the difference between the steroids given for chronic asthma management and acute?
Chronic - inhaled roids
Acute - oral roids
