Flashcards in 30. Asthma Management in Children Deck (45):
Is there a cure for asthma?
No cure, only palliation or spontaneous resolution
What are the main goals of asthma treatment? (5)
- minimal symptoms during day and night
- minimal need for reliever medication
- no exacerbations/ worsening
- no limitation of physical activity
- normal lung function (FEV1>80% predicted or best)
How to measure control of child's asthma? In terms of what to look at (SANE)
Short acting beta agonist/week
Absence of school/nursery
Excertional symptoms/ week
What are classes of medications used to treat child asthma? (6)
1. short acting beta agonists
2. inhaled corticosteroids
3. long acting beta agonists (add ons)
4. leukotriene receptor antagonist (add ons)
5. theophyllines (add ons)
6. oral steroids
Do inhaled corticosteroid doses overlap with adult doses?
Yes; very low, low, medium and high
What should the ICS dose be at the start of asthma treatment? How long after the treatment start should the review be done?
low dose; and review after 2 months
What is the criteria for medication administration for child asthma?
- Max dose ICS 800microgram
- NO oral B2 tablet
- LTRA first line preventer in <5s (leukotriene receptor antagonist)
What is the Step 1 in treating asthma in children?
- SABA (short acting beta agonist)
-inhaled (not oral)
- spacer/ MDI (meter dosed inhaler) or dry powder inhaler
What is the step 2 in treating child asthma?
-REGULAR PREVENTER ( very low dose of inhaled corticosteroids or LTRA in <5s)
; leukotriene receptor antagonist
When should a regular preventer be used? (step 2) (3)
1. if using an inhaled B2 agonist 3x a week or more
2. if symptomatic 3x a week or more or waking one night a week
3. if exacerbations of asthma in the last 2 years
What is the step 3 in treating child asthma?
Add on a preventer (where it becomes more complicated)
What are preventers used to for step 3 of treating child asthma? (3)
1. add on LABA
2. add on LTRA
3. increase ICS dose
What is the stance for high dose therapies in under 5 year olds?
Refer for confirmation of diagnosis
What is the stance for high dose therapies in over 5 year olds?
Increase to medium dose ICS and consider referral
What is always needed before putting a child patient on continuous or regular oral steroids?
What are main advantages of using inhaled corticosteroids?
1. very useful for diagnosis
2. very effective
3. very safe (when prescribed correctly)
What is the safe dose range for inhaled corticosteroids?
What are some adverse effects of ICS; inhaled corticosteroids? (3)
1. height suppression
2. oral candidiasis (thrush)
3. adrenocortical suppression
Which ICS particularly gives bad adverse effects?
What are 2 important things to remember when using long acting beta agonists?
1. do not use without ICS
2. use as fixed dose inhaler
What is the step 4 of treating child asthma?
Long acting beta agonist
What is the step 5 of treating child asthma?
Leukotriene receptor antagonist
What is the leukotriene receptor antagonist used in children? (its name)
In what form does the leukotriene receptor antagonist (LRA), Montelukast appear in for reluctant toddlers?
What is the step 6 of treating child asthma?
Experimental medicine (only needed for minority with genuine severe disease)
When is experimental medicine used? (i.e. what sort of lung issues are needed)
1. 50% physiological
2. > 50% compliance issues
What are two types of delivery methods of treatment for asthma in children?
2. dry powder device
What are the 3 rules for using a spacer?
1. shake inhaler between puffs
2. wash spacer monthly to reduce static
3. each increases delivery by 100%
What is the lung deposition without a spacer?
What is the lung deposition with a spacer?
<20% (better lung deposition)
What are some of the factors which affect lung deposition? (3)
1. with a not tightly fitting face mask
2. crying during inhalation
3. quietly inhaling
What age groups use the dry powder devices?
licensed in over 5s (under 8s cannot use them)
What is the lung deposition in dry powder devices?
Why are MDI spacers more reliable than nebulisers? (6)
3. valve mechanism
4. don't break down
When are nebulisers used in asthmatic patients?
- when high doses of asthma reliever medicines are needed in an emergency
-turns medication into mist and is easier to deliver as it has a mouthpiece and a facemask
-not used day-day
What are other management techniques for child asthma? (2)
1. stop tobacco smoke exposure
2. remove environmental triggers (e.g. cats or house dust mites)
What are the 2 initial steps for treating acute MILD asthma? (starters)
1. SABA via spacer
2. SABA via spacer +prednisolone
What are the 2 next steps for treating acute MODERATE asthma? (main course)
1. SABA via nebuliser +prednisolone
2. SABA +ipratropium via nebuliser +prednisolone
What are the 5 steps for treating acute SEVERE asthma? (specials)
1. IV salbutamol
2. IV aminophylline
3. IV magnesium (nebuliser)
4. IV hydrocortisone
5. Intubate and ventilate
What are the factors that need to be taken into account for deciding how to treat acute asthma? (7)
1. respiratory rate
2. work of breathing
3. heart rate
4. oxygen saturations
5. ability to complete sentences
7. air entry
After treating acute asthma (either mild, moderate or severe), how long should you wait for before reassessing?
What type of steroids are used for chronic/maintenance treatment of asthma?
What type of steroids are used for acute treatment of asthma?
What are MDIs useless without?