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Respiratory System > Asthma Management in Children > Flashcards

Asthma Management in Children Flashcards

1
Q

What is the most important thing to remember when diagnosing asthma?

A

No wheeze, no asthma

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2
Q

What can you say about a cure for asthma?

A

There is no cure, only palliation or spontaneous resolution

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3
Q

What are the goals of asthma treatment?

A

Minimal symptoms during the day and night

Minimal need for reliever medication

No attacks (exacerbations)

No limitations of physical activity

Normal lung function (FEV1 > 70%)

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4
Q

What is the acronym for measuring the control of asthma?

A

SANE

Short acting beta agonist/week

Absence from school

Nocturnal symptoms/week

Exertional symptoms/week

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5
Q

What must be asked when deciding to treat if the asthma is well controlled?

A

No change?

Reduce?

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6
Q

What must be asked when deciding to treat when symptoms are not well controlled?

A

Not taking the treatment? (no change)

Not taking treatment correctly? (no change)

Not asthma? (stop asthma treatment)

None of the above? (increase treatment)

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7
Q

What is the step up and step down approach?

A

Start on a low dose

Review after 2 months

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8
Q

Why do you start on a low dose and increase after reviews?

A

Severe may respond to minimal treatment

It is easier to step up than down

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9
Q

What are some different classes of asthma medicine?

A

Short acting beta agonist

Inhaled corticosteroids (ICS)

Long acting beta agonist

Leukotriene receptor antagonist

Theophylline

Oral steroids

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10
Q

What does ICS stand up for?

A

Inhaled corticosteroids

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11
Q

What should you remember about the guidelines for the treatment of asthma from country to country?

A

They may change

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12
Q

What are contrasts between childrens medication and adults?

A

Max dose ICS 800mg

No oral B2 tablet

LTRA first line prevent in <5s

No LAMAs

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13
Q

What is the max dose of ICS for children?

A

800mg

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14
Q

What does LAMA stand up for?

A

Long acting muscarinic antagonist

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15
Q

When should you use a regular inhaler?

A

B2 agonist > 2 times per week

Symptomatic 3 times a week or more, or waking one night a week

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16
Q

What should be used as a regular inhaler if required?

A

Very low dose corticosteroids (or LTRA in <5s)

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17
Q

What does LTRA stand up for?

A

Leukotreine receptor antagonist

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18
Q

What are advantages of inhaled corticosteroids?

A

Very useful for diagnosis

Very effective

Very safe

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19
Q

What should be remembered about increasing the dose of ICS?

A

Positive effects plateua while adverse effects increase

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20
Q

What are some adverse effects of ICS?

A

Height suppresion

Oral candidiasis

Adrenocortical suppresion

Hypertension

Cataracts

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21
Q

What could be used as additional add on preventors?

A

LABA or LTRA

LTRA

Increase ICS dose

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22
Q

What 2 things should be remembered about long acting beta agonists (LABA)?

A

Do not use without ICS

Use as a fixed dose inhaler

23
Q

What is the drug used as a leukotriene receptor antagonist?

A

Montelukast

24
Q

What is montelukast?

A

Leukotriene receptor antagonist

25
Q

What are advantages of leukotriene receptor antagonists?

A

Better adherance

Granules for reluctant toddlers

26
Q

What are high dose therpies used for in under 5s?

A

Confirmation of diagnosis

27
Q

What should you do if a high dose therapy is required for over 5s?

A

Increase to medium dose ICS and consider referral

28
Q

What should be done if no changes to asthma treatment allows the control of the asthma?

A

Experimental medicine

50% psychological issues

>50% compliance issues

Question the diagnosis

Minority with genuine severe disease

29
Q

What are the 2 kinds of delivery systems?

A

MDI/spacer

Dry powder device (DPD)

30
Q

What should be remembered about children compared to adults?

A

They are less compliant

31
Q

How should inhalers be used?

A

Shake inhaler between puffs

Eash spacer monthly to reduce static

Each of these things increases delivery by 100%

32
Q

What should you do to the inhaler between puffs?

A

Shake it

33
Q

How often should the inhaler be washes?

A

Once per month

34
Q

What does washing the inhaler and shaking it increase delivery by?

A

100%

35
Q

How does using a spacer increase delivery?

A

4x medicine goes to the lungs than had you not used it

36
Q

How much of a drug reaches the lungs when the inhaler is used with a not tightly fitted face mask?

A

0.1%

37
Q

How much of the drug reaches the lungs when the child is crying?

A

1%

38
Q

How much of the drug reaches the lungs when the child is quietly inhaling?

A

8%

39
Q

What age is allowed to use dry powdered devices?

A

Licensed in over 5s (but under 8s cannot use them)

40
Q

What lung deposition does dry powder devices achieve?

A

20%

41
Q

Why is an MDI spacer better than a nebuliser?

A

Quieter

Quicker

Valve mechanism

Don’t break down

Portable

Cheaper

42
Q

What are some non-medical interventions?

A

Stop tobacco smoke exposure

Remove environmental triggers

43
Q

What are some non-medical interventions that people believe, but are not proven by clinical evidence?

A

Diet

Alter humidity

Weight reduction

44
Q

What needs to be considered when deciding which medication to use?

A

Respiratory rate

Work of breathing

Heart rate

Oxygen saturations

Ability to complete sentences

Confusion

Air entry

45
Q

What medicine should be used for mild severity?

A

SABA with spacer

46
Q

What medicine should be used for moderate severity?

A

SABA with nebuliser

47
Q

What medicine should be used for severe severity?

A

IV salbutamol

IV aminophylline

IV magnesium

IV hydrocortisone

48
Q

What should you do for acute asthma reactions?

A

Start treatment and reassess in 1 hour

Step up or down as appropriate

49
Q

What kind of steroids should be used for chronic/maintanence treatment?

A

Inhaled steroids

50
Q

What kinds of steroids should be used for acute treatment?

A

Oral steroids

51
Q

What does SIGN stand up for?

A

Scottish Intercollegiate Guidelines Network

52
Q

What does BTSG stand up for?

A

British Thoracic Society Guidelines

53
Q

What approach does SIGN and BTSG use to asthma treatment?

A

Stepwise approach

54
Q

What is step 1 to 5 of asthma treatment?

A

1) Regular preventor
2) Initial add-on preventor
3) Additional add-on therapies
4) High-dose therapies
5) Continuous or frequent use of oral steroids

Respiratory System (37 decks)

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