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B - Paediatrics MANAGEMENT > Asthma > Flashcards

Asthma Flashcards

1
Q

What it the aim of asthma management?

A

Complete symptom control

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2
Q

What is complete symptom control in asthma management defined as?

A
  • Absence of daytime or nighttime symptoms
  • No limit on activities, including exercise
  • No need for reliever use
  • Normal lung function
  • No exacerbations (need for hospitalisation or oral steroids) in previous 6 months
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3
Q

How is the treatment of asthma determined?

A

It increases from step 1 to step 5, stepping down when control is good

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4
Q

What is step 1 in asthma management?

A

Inhaled short acting ß2 agonist as required

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5
Q

What are short acting ß2 agonists often called?

A

Relievers

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6
Q

Give two examples of short acting ß2 agonists

A
  • Salbutamol

- Terbutaline

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7
Q

After how long is the maximum effect of ß2 agonists?

A

After 10-15 mins

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8
Q

How long are short acting effective for?

A

2-4 hours

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9
Q

On what basis are short acting ß2 agonists used in asthma?

A

‘As required’ for increased symptoms

They can also be used in high doses for acute asthma attacks

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10
Q

What does the device in which inhaled drugs are administered chosen based on?

A

Child’s age and preference

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11
Q

What devices can be used to administer inhaled drugs?

A
  • Pressured metered dose inhaler (and spacer)
    Breath-actuated metered dose inhalers
  • Dry powder inhalers
  • Nebulisers
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12
Q

What age group are pressured metered dose inhalers suitable for?

A

All age groups

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13
Q

What should children aged 0-2 years be given with a pressured metered dose inhaler?

A

Space and face mask

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14
Q

When is a spacer used with a metered dose inhaler?

A

Recommended for all children, but definitely needed in children >3 years

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15
Q

Why are spacers recommended for all children?

A
  • Increases drug depositions for lungs

- Reduced oropharyngeal deposition

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16
Q

What is the advantage of reduced oropharyngeal deposition?

A

It reduces side effects when using a steroid inhaler

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17
Q

Why are spacers useful in acute asthma attacks?

A

Because poor inspiratory effort may impair the use of inhalers directly into the mouth

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18
Q

Who can breath-actuated metered dose inhalers be used in?

A

Children 6+ years

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19
Q

What is the advantage of breath-actuated metered dose inhalers?

A

Less co-ordination is required then with a pressured metered dose inhaler without a spacer

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20
Q

What is the result of breath-actuated metered dose inhalers not requiring a spacer?

A

They are good when ‘out and about’ in older children

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21
Q

What age group are dry powder inhalers useful in?

A

4+ years

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22
Q

When are dry powder inhalers not good?

A
  • Severe asthma

- Acute attack

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23
Q

Why are dry powder inhalers not good in severe asthma or acute attacks?

A

Because they need a good inspiratory flow

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24
Q

What age group are nebulisers used in?

A

Any age

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25
Q

When are nebulisers used?

A

Only in acute asthma, when oxygen is required in addition to inhaled drugs

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26
Q

When can nebulisers be used at home?

A

Occasionally as part of an acute management plan in those with rapid-onset severe asthma

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27
Q

What is ipratropium bromide?

A

An anti-cholinergic bronchodilator

28
Q

What is ipratropium bromide used for?

A

Sometimes given to young infants when other bronchodilators are found to be ineffective, or in treatment of acute severe asthma

29
Q

What is step 2 in asthma management?

A

Regular preventer therapy

30
Q

What is the most effective inhaled preventer therapy?

A

Inhaled corticosteroids

31
Q

What is the action of inhaled corticosteroids?

A

Decrease airway inflammation, resulting in decreased symptoms, asthma exacerbations, and bronchial hyperactivity q

32
Q

What are the side effects of low-dose inhaled corticosteroids?

A

They have no clinically significant side effects when given in low dose, although they cause a mild reduction in height velocity, which is usually followed by a catch-up growth in late childhood

33
Q

What are the side effects of high-dose inhaled corticosteroids?

A

Systemic side effects, such as impaired growth, adrenal suppression, and altered bone metabolism

34
Q

How are the side effects of inhaled corticosteroids minimised?

A

Treatment should always be at lowest dose possible

35
Q

What is step 3 in asthma management?

A

Initial add on therapy

36
Q

What is the first-choice add on therapy in children under 5?

A

An oral leukotriene receptor antagonist

37
Q

Give an example of an oral leukotriene receptor antagonist

A

Montelukast

38
Q

What is the first-choice initial add on therapy in children over 5?

A

LABA (long-acting ß-agonists)

39
Q

What should be done following giving the first-choice initial add on therapy?

A

Assess response

40
Q

What should be done if good response to initial add on therapy in over 5’s?

A

Remain as is

41
Q

What should be done if there is a partial response to initial add on therapy in over 5’s?

A

Increase ICS dose

42
Q

What should be done if there is poor response to initial add on therapy in over 5’s?

A

Stop LABA and increase ICS dose. Consider oral leukotriene receptor antagonist, and/or slow release theophylline

43
Q

Give 2 examples of LABAs

A
  • Salmeterol

- Formoterol

44
Q

How long are LABAs effective for?

A

12 hours

45
Q

When should LABAs not be used?

A
  • Acute asthma

- Without inhaled corticosteroids

46
Q

When are LABAs particularly useful?

A

In exercise-induced asthma

47
Q

What is step 4 in asthma management?

A

Persistent poor control

48
Q

What should be done when there is persistent poor control in <5 year olds?

A

Refer to respiratory paediatrician

49
Q

What should be done when there is persistent poor control in 5-12 year olds?

A

Increase ICS dose

50
Q

What should be done when there is persistent poor control in adolescents and young adults?

A

Increase ICS and consider leukotriene receptor antagonists, or slow release theophylline

51
Q

What is step 5 in asthma management?

A

Continuous or frequent use of oral steroids

52
Q

What inhaled steroid dose should be used in step 5 in 5-12 year olds?

A

You should maintain inhaled steroid dose at 800μg/day

53
Q

What oral steroid dose should be used in step 5 in 5-12 year olds?

A

Use lowest possible dose to maintain adequate control

54
Q

What should be done in addition to giving steroids in step 5 management in 5-12 year olds?

A

Refer to respiratory paediatrician

55
Q

What inhaled steroid dose should be used in step 5 in adolescents and young adults?

A

1600μg/day

56
Q

When is oral prednisolone given in step 5 asthma management?

A

Alternate days

57
Q

Why is oral prednisolone given on alternate days in step 5 asthma management?

A

To minimise the adverse effect on growth

58
Q

Who should all children on oral steroid therapy for asthma be managed by?

A

A specialist in childhood asthma

59
Q

Give an example of an anti-IgE therapy used in asthma

A

Omalizumab

60
Q

Who can administer anti-IgE therapy with omalizumab in asthma?

A

Only a specialist in childhood asthma

61
Q

What is omalizumab?

A

An injectable monoclonal antibody that acts against IgE, which is the natural antibody that mediates allergy

62
Q

What is omalizumab used for?

A

The treatment of severe atopic asthma

63
Q

Are antibiotics useful in asthma?

A

Most antibiotics are of no value in the absence of bacterial infection

64
Q

Are cough medicines and decongestants useful in asthma?

A

No

65
Q

Are anti-histamines useful in asthma?

A

No, but useful in treatment of allergic rhinitis

66
Q

What are the complications of asthma?

A
  • Acute asthma exacerbations
  • Permanent narrowing of airways
  • Missed school days or getting behind in school
  • Poor sleep and fatigue
  • Symptoms that interfere with sports, play, or other activities

B - Paediatrics MANAGEMENT (106 decks)

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