Paeds asthma Flashcards
What age is FeNO testing indicated for in children
- > 5 years
Things to avoid prior to a FeNO test
- using inhaler use 4-6 hours prior
- Resp infections during and stat after
- physical activity 1 hour prior
- eating / drinking
- taking antihistamine 24 hours prior
Paeds Asthma Mx
1st: SABA - Salbutamol
2nd: Low-dose ICS
and if Sx more than once weekly then, add on LTRA montelukast
3rd: ICS + LABA (Formeterol, Salmeterol)
4th: Increase/Higher does of ICS + LABA
5th: Biologics - omalizumab
Paeds Asthma Mx Aim
Complete control of their Sx
- No daytime symptoms.
- No night-time waking due to asthma.
- No need for rescue medication.
- No asthma attacks.
- No limitations on activity including exercise.
- Normal lung function (FEV1and/or PEF > 80%
FeNO Dx criteria for children
> 35 ppb
How to assess baseline asthma status
- Asthma Control Questionnaire or the Asthma Control Test
- Lung Func. test
Mild/moderate asthma exercabation features
- O2 sat. >92%
- Feeding well
- Talking in full sentences
- Crying / vocalising
- no / minimal chest recession
- RR < 30 (over 5’s)
- RR < 40 (under 5’s)
Severe asthma exercabation features
- O2 sat <92%
- PEFR 33-50% predicted
- unable to talk in full sentences
- Not feeding
- Audible wheeze
- HR >125 (>5s), >140 (<5’s)
- chest recession / accessory muscle
Life threatening asthma exacerbation
- O2 sat <92%
- PEFR <33% predicted
- Silent chest
- Cyanosis
- Poor resp effort
- Exhaustion
- Altered consciouness
Respiratory recessions in children
- Nasal flaring
- Subcostal Retraction (Below the rib cage)
- Intercostal Retraction (Intercostal Retraction)
- Suprasternal Retraction (Above the sternum)
- Supraclavicular Retraction (Above the clavicles)
Signs of Severe Respiratory Distress in children
- Increased RR (tachypnea).
- Cyanosis (bluish discoloration of lips, face, or extremities).
- Grunting (a sign that the child is trying to maintain positive pressure in the lungs).
- Using accessory muscles
- Fatigue / Lethargy
- not crying
Acute asthma exacerbationg Mx
- O2 (maintain O2 sat. >94 %)
- Salbutamol nebs
- Ipratropium nebs
- PO prednisolone / IV hydrocortisone
- MgSO4
- Adrenaline
- Escalate
Which med in managing asthma can cause nightmares in children
Montelukast
CXR features of asthma
- Hyperinflation
Peak flow variability range indicative of poor asthma control
- > 20% (poor control)
- > 30% (high risk)
Guideline for children <5 still experiencing Sx with SABA/ICS
NICE advise checking inhaler technique and adherence in children under 5 who are still experiencing symptoms despite a trial of SABA and regular ICS
At what age LABA is not indicated in children
- under 5’s
when is LTRS indicated in asthma Mx for children
Age 5-11 who cannot tolerate MART and whose Sx are not controlled on a low dose ICS.
when is ICS+LABA indicated instead of LTRA for poor asthma control
Age 5-11 who can tolerate/manage combination therapy
Asthma Mx for children under 5 with resolved Sx 8-12 wks after trial Tx
stopping both the ICS and salbutamol and review in 3-month
Aathma Mx for under 5s
- SABA + Low-dose ICS for 8-12wks trial
1st line Ix for Dx asthma
FeNO
What is AIR in asthma Tx
Anti-inflammatory reliever therapy: the use of a combined (ICS+LABA) for Sx relieve ONLY
What is MART Tx in asthma
Maintenance and Reliever Therapy: Use of combined (ICS+LABA) for preventer and reliever
Safe-discharge criteria
- 6-8 puffs at 4h intervals
- O2 sat. >94% RA
- Inhaler technique assessed/taught
- Written asthma plan
- GP f/u within 48 hours
How to use an inhaler device in children under 5s
MDI with a spacer
- shake the inhaler (5-10s)
- Attach the inhaler to the spacer (ensure it’s clean)
- Place mouthpiece / mask (ensure good seal)
- Activate the inhaler
- Have the child breathe in deeply (slow and deep for 5-6 breaths)
- Wait 30-60s between each puffs
- Clean spacer once weekly
what is a Metered-Dose Inhaler
A pressurized inhaler that delivers a specific amount of medication in each dose directly to the lungs
