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.

1
Q

is there a cure for asthma

A

no

only palliation

sometimes spontaneous resolution

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2
Q

what is treatment of asthma based on

A

patient’s experience
- how is it affecting QOL (sleep, exercise, education etc)

take into account severity but focus is on patient

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3
Q

what are the goals of asthma treatment

A

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

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4
Q

how to measure control of asthma - SANE

A

Short acting beta agonist use/wk (>2 days/wk?)

Absence from school/nursery

Nocturnal symptoms/wk (waking >1 night/wk?)

Exertional symptoms/wk

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5
Q

decisions to make when managing asthma

A

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
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6
Q

what to think about if asthma isn’t well controlled

A

not taking treatment

not taking treatment correctly

not asthma - stop asthma treatment

none of the above - increase treatment

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7
Q

step up step down approach to ICS

A

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)
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8
Q

classes of medication for asthma

A

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

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9
Q

BTS/SIGN guideline for asthma management

A

step up step down approach

  • treatment trial to confirm diagnosis
    • ICS doses overlap with adults
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10
Q

differences between management of asthma in children and adults

A

max dose ICS 800mcg (<12y/o)

no oral B2 tablet

LTRA 1st line preventer in <5y/o

no LAMA

only 2 biologics

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11
Q

when to use a regular preventer (step 2)

what do we use

A
  • 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)

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12
Q

what to remember about using LABA as an add on preventer

A

do not use w/o ICS

use as fixed dose inhaler

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13
Q

initial add on preventers (step 3)

A

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)
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14
Q

when to refer to a specialist

A

uncontrolled asthma requiring high dose therapy and continuous oral steroids

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15
Q

severe asthma

A

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

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16
Q

how to approach asthma management

A
  1. what does the individual want to do (lifestyle factors and behaviours)
  2. recognise individuality
  3. objective PFT
  4. adherence to treatment measured
  5. link treatment to 3 and 4
17
Q

what are the 2 types of delivery systems for asthma medications

A

MDI/spacer

dry powder device

18
Q

use of spacers

A

<5% lung deposition w/o spacer

≤20% lung deposition w/ spacer

MDI + spacer = 4x MDI

19
Q

how to improve the efficacy of a spacer

A

shake inhaler between puffs - shake = 2x no shake

wash spacer monthly to reduce static - wash = 2x no wash

20
Q

deposition of inhaled drugs in infants

A

not tightly fitting face mask 0.1%

crying during inhalation 1%

quietly inhaling 8%

21
Q

what are these

when can they be used

lung deposition

A

dry powder devices

licensed in >5, <8 cannot use them

20% lung deposition

22
Q

nebulisers and why are they not commonly used

A

not indicated for day to day use

MDI spacer vs nebuliser:

  • quieter, quicker
  • valve mechanism
  • don’t break down
  • portable and cheaper
23
Q

other management of asthma - lifestyle and environment

A
  • stop tobacco smoke exposure
  • remove environmental triggers - pets, house dust mite
  • diet - evidence is negative
  • no evidence for altered humidity
  • no evidence for weight reduction in improving asthma symptoms