Paeds Respiratory

Question 1

How is acute paediatric asthma managed?

Answer 1

Mild cases can be managed as an outpatient with regular salbutamol inhalers via a spacer (e.g. 4-6 puffs every 4 hours).

Moderate to severe cases require a stepwise approach working upwards until control is achieved:

• Salbutamol inhalers via a spacer device: starting with 10 puffs every 2 hours
• Nebulisers with salbutamol / ipratropium bromide
• Oral prednisone (e.g. 1mg per kg of body weight once a day for 3 days)
• IV hydrocortisone
• IV magnesium sulphate
• IV salbutamol
• IV aminophylline

If you haven’t got control by this point the situation is very serious. Call an anaesthetist and the intensive care unit. They may need intubation and ventilation. This call should be made earlier to give the best chance of successfully intubating them before the airway becomes too constricted.

Question 2

How is chronic asthma managed?

Answer 2

Question 3

What is required for safe asthma discharge?

Answer 3

• PEFR >75%
• Stable on inhaled bronchodilators for 3-4h
• Good inhaler technique, written mx
• Follow up with GP for 1-2 days
• Follow up with paeds asthma clinic in 1-2 weeks

Question 4

What defined a moderate severe and life threatening asthma attack in children

Answer 4