Asthma Flashcards
How are children under 5 diagnosed with asthma?
Based on judgement of symptoms and clinical judgement.
How are children 5 and over diagnosed with asthma?
Based on judgement of symptoms and clinical judgement, as well as spirometry.
How is chronic asthma managed in under 5s?
- SABA
- 8-week trial of paediatric moderate dose ICS if symptoms at presentation indicate need for maintenance (symptoms 3x a week or causing waking at night), or if uncontrolled by SABA alone.
- After 8 weeks, stop ICS and monitor symptoms.
If symptoms did not resolve in trial review for other diagnosis.
If symptoms resolved then reoccurred within 4 weeks of stopping, restart at paediatric low dose.
If symptoms resolved but reoccurred beyond 4 weeks of stopping, repeat 8-week trial.
How should acute asthma/ asthma attack be managed in under 5s?
2.5mg nebulised salbutamol via oxygen driven nebuliser, or pMDI salbutamol 1 puff every 30-60 seconds via a large-volume spacer.
Oxygen if sats <92%
Prednisolone 1-2mg/kg for up to 3 days or IV hydrocortisone if can’t swallow
If poor response to salbutamol: nebulised ipratropium bromide 250mcg every 20-30 mins for 2 hours, then every 4-6 hours.
If poor response: IV magnesium
Monitor PEFR
How should chronic asthma be managed in 5-16 year olds?
- SABA
- Paediatric low dose ICS if symptoms at presentation indicate need for maintenance (symptoms 3x a week or causing waking at night), or if uncontrolled by SABA alone.
- Add LTRA and review response in 4-8 weeks.
- Stop LTRA and add LABA.
- Change to MART regimen (ICS + LABA in 1 inhaler)
- Increase ICS to paediatric moderate maintenance dose either in MART or with LABA.
- Increase ICS to paediatric high maintenance dose OR add additional drug such as theophylline.
What asthma drugs are used off-label in under 18s?
LTRAs
LABAs
MART - ICS + LABA
How should acute asthma / asthma attack be managed in 5-16 year olds?
5mg nebulised salbutamol via 6l/min oxygen driven nebuliser OR pMDI salbutamol 1 puff every 30-60 seconds via a large volume spacer.
Oxygen if sats <92%
Prednisolone: <12 1-2mg/kg od (max 40mg) for up to 3 days. >12 40-50mg daily. If can’t swallow, IV hydrocortisone 100mg every 6 hours.
If poor response to salbutamol: nebulised ipratropium bromide 250mcg every 20-30 mins for 2 hours, then every 4-6 hours.
If poor response: IV magnesium
Monitor PEFR
What should be considered when prescribing ICS?
Monitor height and weight of children on long term ICS treatment annually. If growth slows, refer to paediatrician.
Only beclomethasone is licensed in under 5s.
Prescribe beclomethasone by brand name as Clenil Modulute has a lower potency than Qvar which has a higher potency due to extre-fine particles.
Rinse mouth out after use and use spacer to avoid oral thrush.
How would you explain to a parent/patient how to use a spacer with a mask?
child on parents lap facing them (infant) or sideways or facing away (if older). Older children can also stand or sit facing away on their own.
2. Sit/stand up straight with chin slightly up.
3. Put the inhaler into the back of the spacer so that it is facing the same way up as the mask.
4. Put mask on face to form a seal over nose and mouth.
5. Press inhaler an encourage child to breathe in out 5 times. If a large-volume spacer with a valve is used, a click will be heard with each breath.
6. Remove mask from face.
7. Wait 30 seconds to 1 minute, then repeat if another dose is required.
8. If using ICS, encourage them to swill some water or brush their teeth after using.
How would you explain to a parent/patient how to use a spacer using the long-hold technique?
- Sit/stand up straight with chin slightly up.
- Put inhaler into the back of the spacer.
- Ask to child to breath all the way out slowly.
- Ask them to from a seal with their lips around the mouthpiece.
- Press canister once and have them breathe in slowly and steadily until their lungs feel full.
- Take the mouth piece out of their mouth, and encourage them to close their lips and hold their breath for 10 seconds.
- Have them breathe out away from the inhaler.
- Wait 30 seconds to 1 minute, then repeat if another dose is required.
How would you explain to a parent/patient how to use a spacer using the tidal-breahing technique?
- Sit/stand up straight with chin slightly up.
- Put inhaler into the back of the spacer.
- Ask them to from a seal with their lips around the mouthpiece.
- Encourage them to start breathing in and out slowly.
- Press canister once and have them breathe in and out 5 times.
- Wait 30 seconds to 1 minute, then repeat if another dose is required.
When would the tidal breathing technique be used instead of the long-hold spacer technique?
If the child can’t hold their breath for around 10 seconds or during an asthma attack.
What is the mechanism of action of Montelukast?
Leukotriene receptor antagonist.
Binds to CysLT type 1 receptor to inhibit action of leukotriene C4, D4, and E3, thus decreasing inflammation and relaxing smooth muscle.
What are some side effects of montelukast?
GI discomfort
URTI
Headache
Skin reactions
Neuropyschiatric reactions such as speech impairment or OCD.
How do inhaled beta-2 agonists work?
Activate beta-2 receptors in the airways causing dilatation and smooth muscle relaxation.
