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Semester 2 > Paediatric Asthma Management > Flashcards

Paediatric Asthma Management Flashcards

1
Q

What are the goals of treatment?

A
  • Minimal symptoms during day and night
  • Minimal need for reliever medication
  • No exacerbations
  • No limitation of physical activity
  • Normal lung function
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2
Q

What acronym is used in the measure of control of asthma?

A

SANE

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3
Q

What does sane stand for?

A
  • Short acting beta agonist/week
  • Absence school/nursery
  • Nocturnal symptoms/week
  • Exertional symptoms/week
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4
Q

What are the classes of medications available?

A

-Short acting beta agonists
-Inhaled corticosteroids
Long acting beta agonists
-Leukotriene receptor antagonists
-Theophyllines
-Oral steroids

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5
Q

What kind of approach is taken towards the treatment of asthma?

A

Step up, step down

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6
Q

What is the first step of treatment?

A

Start on low dose ICS then review after 2 months

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7
Q

How does asthma treatment differ from adults?

A
  • Max dose ICS 800 micrograms
  • No oral B2 tablet
  • LTRA first line preventer <5s
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8
Q

What is the very first medication paediatric asthma patients should be on?

A
  • SABA

- Inhaled and using spacer/MDI or dry powder inhaler

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9
Q

When should a regular preventer be considered?

A
  • Use of inhaled B2 agonists 3x a week or more

- Symptomatic 3x a week or more or waking 1 night a week

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10
Q

What regular preventer should be trialled first?

A

Low dose ICS or LTRA in <5s

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11
Q

What options are there when adding on a preventer?

A
  • LABA
  • LTRA
  • Increase ICS
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12
Q

From the options available which is the best to use as an add on preventer?

A

LABA

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13
Q

What should you do if there is still little improvement in the child?

A
  • Under 5s, refer to confirmation of diagnosis

- Over 5s, increase to medium dose ICS and consider referral

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14
Q

What confirmed effects of ICS are there?

A

Very small height suppression

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15
Q

What effects can sometimes occur with ICS?

A
  • Oral candidiasis

- Adrenocortical suppression

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16
Q

What effects do not occur with ICS despite myths?

A
  • Hypertension

- Cataracts

17
Q

What are the 2 things to remember with LABA?

A
  • Do not use without ICS

- Use as fixed dose inhaler

18
Q

What is the only leukotriene receptor antagonist which should be used?

A

Montelukast

19
Q

What are more than 50% of the cases of asthma where control cannot be maintained due to?

A

Compliance issues

20
Q

What is just under 50% of the cases of asthma where control cannot be maintained due to?

A

Psychological issues

21
Q

What is the respiratory tract designed to do?

A

Expel and repel

22
Q

What are the 2 types of delivery systems?

A
  • MDI/ spacer

- Dry powder device

23
Q

How can delivery be increased per puff?

A
  • Shake inhaler between puffs
  • Use a spacer
  • Wash spacer monthly to remove static
24
Q

Who should not be given dry powder inhalers?

A
  • Not licensed in the under 5s
  • Should not be used in under 8s
  • Ideally should not be prescribed to primary school or under
25
Q

What are nebulisers not indicated for?

A

Day to day use

26
Q

What are the benefits of MDI compared to nebulisers?

A
  • Quieter
  • Quicker
  • Valve mechanism
  • Don’t break down
  • Portable
  • Cheap
27
Q

What other non-pharmacological management is there?

A
  • Stop tobacco smoke exposure

- Remove environmental triggers

28
Q

In acute asthma what is the 1st stage of treatment?

A
  • SABA via spacer

- SABA via spacer and pred

29
Q

In acute asthma what is the 2nd stage of treatment?

A
  • SABA via neb and pred

- SABA and ipra via neb and pred

30
Q

In acute asthma what treatments can be added on in order to maintain control?

A
  • IV salbutamol
  • IV aminophylline
  • IV magnesium
  • IV hydrocortisone
  • Intubate and ventilate
31
Q

What must be looked out before treatment is decided for acute asthma?

A
  • RR
  • Work of breathing
  • HR
  • O2 saturation
  • Ability to complete sentences
  • Confusion
  • Air entry
32
Q

What should you do after administering treatment for acute asthma?

A
  • Reassess after 1 hour

- Step up or down as appropriate

33
Q

What kind of steroid should be given in the chronic/maintenance treatment?

A

ICS

34
Q

What kind of steroids should be given in the acute treatment of asthma?

A

Oral steroids

35
Q

What are the take home messages od paediatric asthma management?

A
  • Got to get the diagnosis right
  • Asthma is very steroid sensitive
  • Different approach to under/over 5s
  • MDIs are useless without spacer

Semester 2 (150 decks)

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