Paediatric Asthma Management Flashcards
What are the goals of treatment?
- Minimal symptoms during day and night
- Minimal need for reliever medication
- No exacerbations
- No limitation of physical activity
- Normal lung function
What acronym is used in the measure of control of asthma?
SANE
What does sane stand for?
- Short acting beta agonist/week
- Absence school/nursery
- Nocturnal symptoms/week
- Exertional symptoms/week
What are the classes of medications available?
-Short acting beta agonists
-Inhaled corticosteroids
Long acting beta agonists
-Leukotriene receptor antagonists
-Theophyllines
-Oral steroids
What kind of approach is taken towards the treatment of asthma?
Step up, step down
What is the first step of treatment?
Start on low dose ICS then review after 2 months
How does asthma treatment differ from adults?
- Max dose ICS 800 micrograms
- No oral B2 tablet
- LTRA first line preventer <5s
What is the very first medication paediatric asthma patients should be on?
- SABA
- Inhaled and using spacer/MDI or dry powder inhaler
When should a regular preventer be considered?
- Use of inhaled B2 agonists 3x a week or more
- Symptomatic 3x a week or more or waking 1 night a week
What regular preventer should be trialled first?
Low dose ICS or LTRA in <5s
What options are there when adding on a preventer?
- LABA
- LTRA
- Increase ICS
From the options available which is the best to use as an add on preventer?
LABA
What should you do if there is still little improvement in the child?
- Under 5s, refer to confirmation of diagnosis
- Over 5s, increase to medium dose ICS and consider referral
What confirmed effects of ICS are there?
Very small height suppression
What effects can sometimes occur with ICS?
- Oral candidiasis
- Adrenocortical suppression
What effects do not occur with ICS despite myths?
- Hypertension
- Cataracts
What are the 2 things to remember with LABA?
- Do not use without ICS
- Use as fixed dose inhaler
What is the only leukotriene receptor antagonist which should be used?
Montelukast
What are more than 50% of the cases of asthma where control cannot be maintained due to?
Compliance issues
What is just under 50% of the cases of asthma where control cannot be maintained due to?
Psychological issues
What is the respiratory tract designed to do?
Expel and repel
What are the 2 types of delivery systems?
- MDI/ spacer
- Dry powder device
How can delivery be increased per puff?
- Shake inhaler between puffs
- Use a spacer
- Wash spacer monthly to remove static
Who should not be given dry powder inhalers?
- Not licensed in the under 5s
- Should not be used in under 8s
- Ideally should not be prescribed to primary school or under
What are nebulisers not indicated for?
Day to day use
What are the benefits of MDI compared to nebulisers?
- Quieter
- Quicker
- Valve mechanism
- Don’t break down
- Portable
- Cheap
What other non-pharmacological management is there?
- Stop tobacco smoke exposure
- Remove environmental triggers
In acute asthma what is the 1st stage of treatment?
- SABA via spacer
- SABA via spacer and pred
In acute asthma what is the 2nd stage of treatment?
- SABA via neb and pred
- SABA and ipra via neb and pred
In acute asthma what treatments can be added on in order to maintain control?
- IV salbutamol
- IV aminophylline
- IV magnesium
- IV hydrocortisone
- Intubate and ventilate
What must be looked out before treatment is decided for acute asthma?
- RR
- Work of breathing
- HR
- O2 saturation
- Ability to complete sentences
- Confusion
- Air entry
What should you do after administering treatment for acute asthma?
- Reassess after 1 hour
- Step up or down as appropriate
What kind of steroid should be given in the chronic/maintenance treatment?
ICS
What kind of steroids should be given in the acute treatment of asthma?
Oral steroids
What are the take home messages od paediatric asthma management?
- Got to get the diagnosis right
- Asthma is very steroid sensitive
- Different approach to under/over 5s
- MDIs are useless without spacer
