Asthma Management in Children Flashcards
Goals of treatment (5)
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
How to measure control (5)
Closed questions Short acting beta agonist/week Absence from school Nocturnal symptoms/week Exertional symptoms
Step up step down approach
Start on a low dose
Review after 2 months
Classes of Medications
Short acting beta agonists Inhaled corticosteroids Long acting beta agonists Leukotriene receptor agonists Theophylline Oral steroids
Step 2 Regular preventer
Diagnostic test
B2 agonist
Start on very low dose of inhaled corticosteroids
What are the adverse effects of inhaled corticosteroids
Height suppression
Oral candidiasis
Adrenocortical suppression
Step 3 Initial add on preventer
Add on LABA or LTRA
Increase ICS dose
What can’t LABA be used without
ICS
What can you add to be used with LABA
LTRA
Features of LTRA
Montelukast only (tablets)
Rule of thirds
Better adherence
Granules for reluctant toddlers
Other management of asthma
Stop tobacco smoke exposure
Remove environmental triggers
How to choose treatment (9)
Look at patient Respiratory rate Work of breathing Work of breathing HR Oxygen saturations Ability to complete sentences Confusion Air entry
Treatment for mild acute asthma
SABA via spacer
SABA via spacer + pred
Treatment for moderate acute asthma
SABA via neb + pred
SABA + ipra via neb + pred
Treatment for severe acute asthma
IV salbutamol IV aminophylline IV magnesium (neb) IV hydrocortisone Intubate and ventilate
