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Flashcards in Management of Asthma in Children Deck (30)
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1
Q

What are the main goals of asthma treatment?

A

Minimal symptoms during the day and night

Minimal need for reliever medication

No attacks (exacerbations)

No limitation of physical activity

(normal lung function, FEV1 & PEFR > 80% predicted / best)

2
Q

What questions should be asked to decipher how well controlled a patients asthma is?

A

Mnemonic - SANE:

  • Short acting beta agonist use per week?
  • Absences at school due to condition
  • Nocturnal symptoms experienced per week?
  • Excertional symptoms per week?
3
Q

How many times is the upper limit for an asthma patient using their SABA per week?

A

2 times

If they are using their blue inhaler more than 2 times per week they are poorly controlled

4
Q

How often should a well controlled asthma patient be experiencing nocturnal and excertional symptoms per week?

A

They shouldn’t

Experiencing these symptoms indicated poor control

5
Q

If an asthma patient has been well controlled for more than 3 months, what should be considered?

A

Stepping down their treatment

Might not be needing treatment to the extent they’re recieving it

6
Q

What is the first step in asthma management?

A

2 months of low dose inhaled ICS. Always first step bc part of the diagnostic process

Review effect after 2 months

(Need to take a break from the inhaler to make sure it’s actually asthma, usually done around easter bc low chance of infection & exacerbation)

7
Q

What classes of medications are available for the treatment of paediatric asthma?

A
Short acting beta agonists (SABA)
Inhaled corticosteroids 
Long acting beta agonists (LABA)
Leukotriene receptor antagonists 
Theophyllines 
Oral steroids
8
Q

What is the first line treatment for paediatric asthma in the stepwise progression?

A

Inhaled corticosteroids for children > 5yrs

Leukotriene receptor agonists for children under 5 years of age

9
Q

What is the maximum dose of ICS in children?

A

800 microg

10
Q

What symptoms would indicate a trial of ICS should be started? (or LRTA’s in under 5s)

A
  • Symptomatic 3 or more times per week (need blue inhaler)

- waking 1 or more nights per week

11
Q

What is one possible side effect of using too high a dosage of ICS?

A

Adrenocortical suppression

12
Q

What are 2 things to remember when it comes to using long acting beta agonists?

A

Don’t use without ICS

Give them in a fixed dose inhaler

13
Q

How do kids tend to respond to treatment with LRTA’s? What is one advantage of them?

A

Rule of thirds (1/3 good response, 1/3 some response, 1/3 no response)

Better adherence due to tablet / granule form

14
Q

What is the second step in asthma treatment? (already on ICS)

A

Add on a LABA

This doesn’t work best for everyone though and response in some individuals is better with:

  • LTRA added on
  • Increased ICS dose
15
Q

What are the two types of severe asthma?

A
  1. Treatment resistant asthma (very rare in paeds)
  2. Troublesome asthma (the patient says they’re taking the treatment, but they aren’t taking the treatment - may have psychological / domestic issues)
16
Q

If a patient has severe treatment resistant asthma what class of drugs is available?

A

Biologics

omalizumab / Mepolizumab

17
Q

What is one group of asthma treatment medications that is not available for chilfdren?

A

LAMA’s

18
Q

What are the two types of delivery systems for asthma medications?

A

Meter dosed inhaler +spacer (can use without spacer but you get less than 5% of the medication in your lungs compared to 20% with spacer)

Dry powder device

19
Q

What are two important things to remember when using inhalers with spacers?

A

Shake the inhaler before using

Wash the spacer monthly with detergent

20
Q

Which medication delivery devices are used by children of different ages?

A

under 8s - MDI + spacer

Boys 8-11 - MDI + spacer

Girls 8-11 - dry powder device

12+ - MDI

21
Q

When are nebulisers used? What is a nebuliser?

A

Not usually

Maybe if the person is unconscious, but they have low drug deposition and intrinsic mechanics break down more often so not much upside

Basically an oxygen mask but spits out meds instead

22
Q

What are some non-pharmacological methods of improving childs asthma?

A

Stop smoking (usually directed at parents)

Removing environmental triggers (such as cats if they trigger the child - if they don’t trigger them then they’re chill)

23
Q

What medication would be given to a child that is suffering a mild asthma attack?

A

SABA via a spacer

Or if more severe:
SABA via a spacer + prednisolone

24
Q

What medication would be given to a child that is suffering a moderate asthma attack?

A

SABA via a spacer + prednisolone

Or if more severe:
SABA via spacer + ipratropium bromide via nebuliser + prednisolone

25
Q

What does ipratropium bromide do?

A

Bronchodilator

26
Q

For children experiencing severe asthma attacks, what treatment options are available?

A
  • IV salbutamol
  • IV aminophylline
  • IV magnesium
  • IV hydrocortisone
  • Intubation and ventilation
27
Q

If a patient presents to the hospital having an asthma attack and seems very agitated or otherwise strange, what may they be suffering from?

A

Hypoxia causing confusion

28
Q

What are some of the factors that you need to pay close attention to when first examining the patient presenting with an acute asthma attack?

A
Resp and heart rate
Work of breathing 
Oxygen saturation
Ability to speak (complete sentences without breathing?)
Confusion
Air entry 

Presence of symptoms indicates severity and therefore treatment

29
Q

What signs are seen when a child is having a respiratory attack?

A

Stomach bulging in and out (due to force of diaphragmatic contractions)

Contraction of the intercostal muscles

Tracheal tug

30
Q

What is the difference between the steroids given for chronic asthma management and acute?

A

Chronic - inhaled roids

Acute - oral roids