management of non-acute asthma in children Flashcards
• Know the stepwise approach to management of asthma, including drugs and their delivery, patient education. • Know how to assess and manage severe and life-threatening asthma.
is there a cure for asthma
no
only palliation
sometimes spontaneous resolution
what is treatment of asthma based on
patient’s experience
- how is it affecting QOL (sleep, exercise, education etc)
take into account severity but focus is on patient
what are the goals of asthma treatment
minimal symptoms during day and night
minimal need for reliever medication (<2 days/wk)
no attacks/exacerbations
no limitation of physical activity
normal lung function - FEV1 and/or PEF >80% predicted or better
how to measure control of asthma - SANE
Short acting beta agonist use/wk (>2 days/wk?)
Absence from school/nursery
Nocturnal symptoms/wk (waking >1 night/wk?)
Exertional symptoms/wk
decisions to make when managing asthma
are symptoms controlled
is treatment being taken
will this treatment change help
if well controlled: reduce treatment/no change?
- consider stepping down if completely symptom free for 3mths
what to think about if asthma isn’t well controlled
not taking treatment
not taking treatment correctly
not asthma - stop asthma treatment
none of the above - increase treatment
step up step down approach to ICS
start on low dose ICS - severe asthma may respond to minimal treatment
review after 2mths
- no change is easier than step down
- consider inhaler holiday to see if symptoms return (do it over easter as coughs and colds are less common so exacerbation is less likely)
classes of medication for asthma
SABA - short acting beta agonists
ICS - inhaled corticosteroids
LABA - long acting beta agonists (add on)
LTRA - leukotriene receptor antagonists (add on)
theophyllines (add on)
oral steroids - not commonly used in paeds
BTS/SIGN guideline for asthma management
step up step down approach
- treatment trial to confirm diagnosis
- ICS doses overlap with adults
differences between management of asthma in children and adults
max dose ICS 800mcg (<12y/o)
no oral B2 tablet
LTRA 1st line preventer in <5y/o
no LAMA
only 2 biologics
when to use a regular preventer (step 2)
what do we use
- as part of a diagnostic test
- if using B2 agonist >2x/wk
- symptomatic ≥3x/wk or waking 1night/wk
start w/ very low dose ICS (or LRTA in <5s)
what to remember about using LABA as an add on preventer
do not use w/o ICS
use as fixed dose inhaler
initial add on preventers (step 3)
add on LABA or LTRA (BTS/SIGN)
add on LTRA (NICE)
increase ICS dose (GINA)
- ADD ON LABA BUT KEEP OPEN MIND (additional add-on therapies - increase ICS, LTRA)
when to refer to a specialist
uncontrolled asthma requiring high dose therapy and continuous oral steroids
severe asthma
50% psychological issues, >50% compliance issues
very small amount of people w/ genuine severe disease
remainder have troublesome asthma - behaviour around their condition is abnormal and might reflect on: attention seeking behaviour, underlying individual/familial psychological issue