8.0b Wk7 Asthma - Kids

Question 1

What is the first challenge of Asthma in Kids?

Answer 1

Diagnosis – Coughs, Sneezes, runny nose, colds etc common

Question 2

What are the signs and symptoms of Asthma in Kids?

Answer 2

Tight Chest
Wheeze
Triggered by pollon, house dust, exercise, cold weather

Question 3

Risk Factors

Answer 3

Intrinsic factors include (inside the body)
○ Family history of asthma or ecezma
○ Premature birth / Low birth rate
○ Stress in any form
○ Obesity

Extrinsic factors include (outside the body)
○ Allergens
○ Exposure to cigarette smoke as a child
○ Occupational factors e.g. chemicals
○ irritants in the air i.e. pollution

Question 4

Triggers

Answer 4

The common cold
Allergens e.g. house dust mites, pollen
Exercise
Stress and other emotions
Exposure to hot or cold air
Pollution
Medicines (e.g. NSAIDs)

Question 5

Signs and Syptoms

Answer 5

On examination
○ Dyspnoea (Breathless)
○ Wheezing (Especially on expiration)
○ Increased respiratory rate
○ Blue tinge to lips or fingers
○ Tachycardia

Patient/parent complains of
○ Dry coughing, typically early morning or at night
○ Chest tightness
○ History of fainting
○ Season variation – Worse in summer owing to pollen counts

Question 6

3 investigations you might consider using with kids?

Answer 6

Fractional exhaled Nitric Oxide (FeNO) test - Measures airway inflamation

An increase in exhaled NO may suggest there is an induction of Nitric Oxide Synthase 2 that is found to be increased in airway epithelial cells of asthmatic patients

Peak flow measurement - Measured forced expiratory volume over time

Airway hyperreactivity test - Asthmatics react to histamine or metacholine, none asthmatics do not.

Question 7

What are the goals of treatment?

Answer 7

○ No daytime symptoms
○ No night time awakening due to asthma
○ No exacerbations
○ No limitations on activity including exercise
○ Minimal side effects from medication
○ No need for rescue medication
○ Normal lung function

Question 8

What is the non pharmacological approach to treating Asthma?

Answer 8

Primary prevention measures include:
○ Remove from passive smoking environment
○ Advise to avoid any triggers including allergens or pollution
○ Healthy diet and level of exercise

Secondary prevention measures include:
○ Reduce house dust mite risk
○ Breathing and relaxation exercises

Question 9

What is the therapeutic approach to treating asthma in kids < 5 years.

Answer 9

If less than 5 years

SABA then

Add very low dose ICS or LTRA then

Combine very low dose ICS + LTRA then

Increase **very low dose ICS to Low dose ICS + Continue LTRA then

* Refer to specialist

Question 10

What is the therapeutic approach to treating asthma in kids > 5 years.

Answer 10

If > 5 years

SABA

Add very low dose ICS

Combine very low dose ICS + (LABA or LTRA)

Increase very low dose ICS to Low dose ICS + Continue (LABA or LTRA)

Refer to specialist

Question 11

How do you treat acute moderate asthma

Answer 11

Moderate Asthma

* Oxygen saturation levels > 92% (SPO2 >92%)
* Bronchodilator e.g. via spacer
* Oral prednisolone 30 – 40mg

Question 12

How do you treat acute severe asthma?

Answer 12

Acute severe asthma

* Oxygen saturation levels < 92% (SPO2 <92%)
* Oxygen
* Nebulised salbutamol
* ? IV hydrocortisone
* Nebulised Ipratropium Bromide

Question 13

How do you treat a life threatening asthma attack?

Answer 13

Life threatening Asthma

* Oxygen saturation levels < 92% (SPO2 <92%)
* Oxygen
* Nebulised salbutamol
* ? IV hydrocortisone
* May transfer to ICU

Question 14

What is an important way of preventing an acute attack?

Answer 14

• How to use an inhaler
  
  • How to use a spacer – Volumatic spacer or Air chambers
  • Understand when to use preventor medication

Question 15

How to use an inhaler, air chamber, volumatic spacer

Answer 15

Go to asthma uk and take a look at the video.