Paeds asthma Flashcards
(27 cards)
What age is FeNO testing indicated for in children
- > 5 years
Things to avoid prior to a FeNO test
- using inhaler use 4-6 hours prior
- Resp infections during and stat after
- physical activity 1 hour prior
- eating / drinking
- taking antihistamine 24 hours prior
Paeds Asthma age 5-11 Mx
1st: offer BD paed Low-dose ICS + SABA - Salbutamol PRN
2nd: MART regime: Paed low dose MART (ICS/LABA (formeterol))
OR
Conventional regime: Consider BD LTRA montelukast trial 8-12/52 (if cannot tolerate MART)
3rd: MART regime: Increase to paed moderate does MART
OR
Conventional regime: offer BD paed low dose ICS/LABA + SABA PRN (+/-LTRA); if ineffective Switch to BD moderate dose ICS/LABA + SABA PRN (+/-LTRA)
Refer to resp if Sx not controlled by paed moderate dose MART OR paed moderate dose ICS/LABA
Paeds Asthma Mx Aim
Complete control of their Sx
- No daytime symptoms.
- No night-time waking due to asthma.
- No need for rescue medication.
- No asthma attacks.
- No limitations on activity including exercise.
- Normal lung function (FEV1and/or PEF > 80%
FeNO Dx criteria for children
> 35 ppb
How to assess baseline asthma status
- Asthma Control Questionnaire or the Asthma Control Test
- Lung Func. test
Moderate asthma exercabation features in children
- Talking in full sentences
- O2 sat. >92%
- PEF >50% of predicted
- RR < 40, HR < 140 (under 5’s)
- RR < 30, HR < 125 (over 5’s)
Severe asthma exercabation features in children
- unable to talk in full sentences or feed
- Use of accessory neck muscle
- O2 sat < 92%
- PEF 33-50% predicted
- RR > 40, HR > 140 (under age 5)
- RR > 30, HR 125 (over age 5)
Life threatening asthma exacerbation in children
- O2 sat <92%
- PEFR <33% predicted
- Silent chest
- Cyanosis
- Poor resp effort
- Exhaustion
- Altered consciouness
Respiratory recessions in children
- Nasal flaring
- Subcostal Retraction (Below the rib cage)
- Intercostal Retraction (Intercostal Retraction)
- Suprasternal Retraction (Above the sternum)
- Supraclavicular Retraction (Above the clavicles)
Signs of Severe Respiratory Distress in children
- Increased RR (tachypnea).
- Cyanosis (bluish discoloration of lips, face, or extremities).
- Grunting (a sign that the child is trying to maintain positive pressure in the lungs).
- Using accessory muscles
- Fatigue / Lethargy
- not crying
Acute severe asthma exacerbation Mx in children
- High flow O2 (maintain O2 sat. 94-98 %)
- Salbutamol nebs
if no response to Tx then add - Ipratropium nebs
- PO prednisolone OR IV hydrocortisone
- MgSO4
- Adrenaline
- Escalate
Which med in managing asthma can cause nightmares in children
Montelukast
CXR features of asthma
- Hyperinflation
Peak flow variability range indicative of poor asthma control
- > 20% (poor control)
- > 30% (high risk)
Guideline for children <5 still experiencing Sx with SABA/ICS
NICE advise checking inhaler technique and adherence in children under 5 who are still experiencing symptoms despite a trial of SABA and regular ICS
At what age LABA is not indicated in children
- under 5’s
when is LTRA indicated in asthma Mx for children
Age 5-11 who cannot tolerate MART and whose Sx are not controlled on a paed low dose ICS + SABA.
when is MART indicated instead of LTRA for poor asthma control
Age 5-11 who can tolerate/manage combination therapy
Aathma Mx for under 5s
- BD low dose ICS + SABA for 8-12wks trial
- Stopping both the ICS and salbutamol if Sx resolved during 8-12 wks trial and review in 3-month
- Restart SABA + Low-dose ICS if Sx recur or child requires steroid/hospitalisation
- Up titrating to BD moderate dose ICS + SABA
- add LTRA (trial for 8-12 wks)
- Refer to specialist if uncontrolled Sx
1st line Ix for Dx asthma
FeNO
What is AIR in asthma Tx
Anti-inflammatory reliever therapy: the use of a combined (ICS+LABA) for Sx relieve ONLY
What is MART Tx in asthma
Maintenance and Reliever Therapy: Use of combined (ICS+LABA) for preventer and reliever
Safe-discharge criteria
- 6-8 puffs at 4h intervals
- O2 sat. >94% RA
- Inhaler technique assessed/taught
- Written asthma plan
- GP f/u within 48 hours
