Asthma Management Children Flashcards
(50 cards)
What guidelines are available
BTS/SIGN - UK,Australia and EU
GINA - America
NICE - UK
What are the 5 goals of treatment
Minimal” symptoms during day and night Minimal need for reliever medication No attacks (exacerbations) No limitation of physical activity Normal lung function (in practical terms FEV1 and/or PEF >80% predicted or best)
What acronym can be used to assess a patients control of asthma
SANE
What does SANE stand for
Short acting beta agonist/week
Absence school/nursery
Nocturnal symptoms/week
Excertional symptoms/week
What question can be asked to assess S in SANE
How many days a week do you need your blue inhaler?
More than 3 days indicates that the asthma is poorly controlled
What does A in SANE indicate
It is a quality of life indicator
How may you know that a patients asthma is poorly controlled using N in SANE
If nocturnal symptoms occur more than once a week it indicates that the asthma is poorly controlled
What should be done if the patients asthma is well controlled
The medication can either be reduced or nothing changed
What should be done if the patients asthma is not well controlled
Check that:
Treatment is being taken
Treatment is being taken correctly
If they have asthma
If it is found that the treatment is not being taken or not being taken correctly, what should be done
Nothing (no change to asthma treatment)
Reiterate compliance
Teach technique
If it is found that they are taking their treatment and they are taking it correctly, what should be done
Dose may be increased
What dose of ICS should a patient be started on and why
Low dose of ICS
Even severe asthma may be able to respond to minimal treatment
When should the treatment given to the patient be reviewed
After 2 months
Is there a routine test to monitor the patients progress
No
What are the 6 classes of medications
Short acting beta agonists - blue Inhaled corticosteroids (ICS) Long acting beta agonists Leukotriene receptor antagonists Theophyllines Oral steroids
Which medications are known as add ons
Long acting beta agonists
Leukotriene receptor antagonists
Theophyllines
What has changed in the 2016 BTS/SIGN guidelines
It now provides one figure for all children and adults
The ICS doses overlap between children and adults
It acknowledges the areas of uncertainty when ICS are not sufficient
What are the ICS doses available
Very low
Low
Medium
High
What are the 5 differences between treatment in adults and children
Maximum dose of ICS in children is 800mg There is no oral β2 tablet LTRA is the first line preventer in under 5’s There are no LAMA’s There is only one biological product
What is the first step of asthma treatment in children
SABA as required
The child should be provided inhaled (not oral) short acting beta agonists with a spacer/MDI or a dry powder inhaler
What is the second step of treatment
Use of a regular preventer
In what 3 circumstances should the child be given the 2nd step of treatment
When:
They are using inhaled β2 agonists three or more times a week
They are symptomatic three or more times a week or waking up one night a week
When they have had exacerbations of asthma in the last two years
What should the 2nd step of treatment be started with
Very low dose of inhaled corticosteroids
LTRA in under 5’s
What is done in step 3 of treatment
An add on preventer is added on
