1 / 55

Asthma in Children Asma in Kinders

Asthma in Children Asma in Kinders. P rof Sharon Kling Stellenbosch University & Tygerberg Children’s Hospital. Outcomes / Uitkomste. Clinical definition How common is asthma? How do we diagnose asthma in children? Other causes of wheezing in children

jethro
Download Presentation

Asthma in Children Asma in Kinders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Asthma in ChildrenAsma in Kinders Prof Sharon Kling Stellenbosch University & Tygerberg Children’s Hospital

  2. Outcomes / Uitkomste • Clinical definition • How common is asthma? • How do we diagnose asthma in children? • Other causes of wheezing in children • Management of asthma in children • Kliniesedefinisie • Hoe algemeen is asma? • Hoe diagnoseeronsasma in kinders? • Ander oorsake van fluitbors in kinders • Hantering van asma in kinders

  3. Children are NOT small adults! • Different anatomy • Congenital abnormalities: causes of wheezing • Different physiology • Growth • Drug handling • Anatomieverskil • Kongenitaleafwykings: oorsake van fluitbors • Fisiologieverskil • Groei • Hantering van middels

  4. The Global Burden of AsthmaDie Globale Las van Asma • Very common • 300 million people worldwide • More prevalent in western lifestyles and urban areas • Asthma mortality is also increasing and is alarmingly high • Baiealgemeen • 300 miljoenmensewêreldwyd • Meer algemeenwaarwesterseleefstyl en stedelike areas • Asmamortaliteitvermeerder en is baiehoog

  5. Angelo’s story • Presented to allergy clinic at age 10 years: asthma • Brother Julio had died 6 months previously after an acute asthma attack • Julio had been using up a full Ventolin® asthma pump every week – obtained from GP and pharmacy Names changed to preserve confidentiality

  6. Angelo 2 • How would you feel if you were Angelo? • What problems do you identify in this short scenario?

  7. Definition / definisie • Asthma is a lung disease with: • Airway obstruction that is reversible(spontan-eouslyor with treatment); • Airway inflammation; and • Increased airway responsiveness to a variety of stimuli • Asma is ‘n long-siekte met: • Lugwegobstruksiewatomkeerbaar is (spon-taan of nabehandeling); • Lugweginflammasie; en • Verhoogdelugwegresponsiwiteittot ‘n verskeidenheid van stimuli

  8. Risk factors / Risikofaktore • Genetic / Geneties • Allergen exposureAllergeenblootstelling • Environmental exposuresOmgewingsblootstellings

  9. Clinical Definition of AsthmaKlinieseDefinisie van Asma • Recurrent wheezing with or without a cough Herhaalde fluitbors met of sonder hoes • That respondsto a bronchodilatorRespondeer op ‘n brongodilator

  10. Diagnosis / Diagnose • History / Geskiedenis • Examination / Ondersoek • Special investigations / Spesialeondersoeke • Lung functions / longfunksies • Allergy tests / allergietoetse • Exclude other causes of wheezingSkakelanderoorsake van fluituit

  11. History / Geskiedenis

  12. History / Geskiedenis 1 • Repeated episodes of wheezing or tight chest • Cough, espat night • Early morning waking • Wheeze or cough after physical activity • Symptoms relieved when bronchodilator is used • Herhaalde episodes fluit- of toebors • Hoes, veral snags • Word vroegoggendwakker • Fluit of hoes naoefening • Simptomeverbeternabrongodilator

  13. History / Geskiedenis 2 • Symptoms worse during certain seasons • Triggers that worsen asthma • Allergens • Irritants • Simptomeergertydenssekereseisoene • Snellerfaktorewatasmavererger • Allergene • Prikkelendemiddels

  14. Allergens / AllergeneInhaled / inhalasie

  15. Irritants / Prikkelendemiddels

  16. History / Geskiedenis 3 • History of other allergic diseases • Allergic rhinitis • Eczema • Allergic conjunctivitis • Family history of asthma or allergy • Geskiedenis van anderallergiesetoestande • Allergieserinitis • Ekseem • Allergiesekonjunktivitis • Familiegeskiedenis van asma of allergie

  17. Examination Ondersoek

  18. ExaminationOndersoek • Growth / groei • Allergic appearance / allergiesevoorkoms • Chest deformities / Borskasdeformiteite • Hyperinflation, wheezesHiperinflasie, fluite • Other allergic conditionsAnder allergiesetoestande

  19. Special InvestigationsSpesialeOndersoeke • Lung function testing (> 6 years)Longfunksietoetse (> 6 jaar) • Identify specific allergens Identifiseerspesifiekeallergene • Skin prick tests / Velpriktoetse • Radioallergosorbent tests (RAST) • Exclude other causes of wheezingSkakelanderoorsake van fluituit

  20. Differences: Children and AdultsVerskille: Kinders en Volwassenes • Mimics of asthma • Diagnosis in young child difficult • More allergy • Lung functions difficult in young child • Drug delivery systems • Safety of medications • Toestandewatasmanaboots • Diagnose moeilik in jong kind • Verhoogdeallergie • Longfunksiesmoeilik • Lewering van middels • Veiligheid van middels

  21. Causes of recurrent wheezing in childrenOorsake van herhaalde fluitbors in kinders • Asthma • Post-viral wheezing (bronchiolitis) • Congenital lung abnormalities • TB (lymph nodes obstructing airways) • Gastro-oesophageal reflux • Cystic fibrosis • Immune deficiency • Asma • Postvirale fluitbors (brongiolitis) • Kongenitale long afwykings • TB (limfnodeswatlugweëobstrukteer) • Gastroesofagealerefluks • Sistiesefibrose • Immuungebrek

  22. Wheezing in the first 6 years of lifeFluit in die eerste 6 jaar van lewe Post viral/ viraal Asthma/ asma Martinez 1995

  23. Wheezing studies in children • Many children (about half) will wheeze when young • Some of them will outgrow wheezing • Some will continue to wheeze • Difficult to distinguish these groups • Baiejongkinders (omtrent die helfde) salfluitborshê • Sommigesal die fluitontgroei • Sommigesalvoortgaan met fluitbors • Moeilikomteonderskei

  24. Exclude other causes of wheezingSkakelanderoorsake van fluituit • Chest X-ray: congenital abnormalities, TB • Sweat test: cystic fibrosis • Barium swallow, pH study: gastro-oesophagealreflux • Tests of immunity • Borskasplaat: kongenitaleafwykings, TB • Sweettoets: sistiesefibrose • Bariumsluk, pH studie: gastroesofagealerefluks • Immuuntoetse

  25. Management / Hantering • Education • Avoid allergens • Environmental control (cigarette smoke) • Avoid triggers • Controlasthma symptoms • Relieve acute attacks of asthma • Opvoeding • Vermyallergene • Omgewingsbeheer (sigaretrook) • Vermysnellers • Beheerasmaaanvalle • Verligakuteasmaaanvalle

  26. Management Environmental control Asthma Education Medication

  27. Preventative / Avoidance Measures

  28. Management of Asthma in Children Classify Severity Institute treatment Follow-up, assess control Step therapy up or down

  29. ASTHMA SEVERITY CLASSIFICATION

  30. Types of Medications • Long-term “controller” medicationLangtermyn “kontrolleerder” medikasie • Anti-inflammatory, inhaled corticosteroids, e.g. budesonide • Quick-relief rescue “reliever” medicationVinnigwerkende “verligter” medikasie • Bronchodilator, beta-2 agonists, e.g. salbutamol

  31. Short acting ß2 agonist (bronchodilator) as necessary (reliever only) Step-wise management 1 • Step 1: mild intermittent Modified from BTS SIGN guidelines 2005

  32. Step 2: Persistent Sx: introduce regular controller Rx Inhaled steroids – start at dose appropriate to severity of disease (200 – 400 mcg/day, in two divided doses) Safe ICS dose in children 400 mcg/day Step-wise management 2 + Short acting ß2 agonist as necessary Modified from BTS SIGN guidelines 2005

  33. ICS dose 400 mcg/day

  34. How to Use a Metered-dose Inhaler (MDI) Evaluate inhaler technique at each visit. Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma Created and funded by NIH/NHLBI

  35. Delivery systems: Spacers

  36. Home-made spacer: 500 ml cold drink bottle with mask

  37. Home-made spacer: 500 ml cold drink bottle without mask

  38. Assess controlEvalueerbeheer

  39. Asthma control Pharmacological management. Thorax 2003; 58 (Suppl I): i1-i92

  40. If asthma control poor, assess:As asmabeheerswak is, evalueer: • Is the diagnosis correct? • Is the child using the medication? -“adherence” • Technique • Delivery system ok? • Triggers and allergen avoidance? • Is diagnose korrek? • Gebruik die kind die medikasie? • Tegniek • Leweringstelsel ok? • Snellers en allergeenvermyding?

  41. Options for achieving asthma controlBehandelingsmoontlikhede • Increase inhaled steroid dose • Add on other asthma drugs • Long-acting ß2 agonist or • Leukotriene receptor antagonist or • Theophylline sustained release • Oral corticosteroids (prednisone) • Vermeerderinhalasiesteroïededosering • Voeganderasmamiddels by • Langwerkendeß2 agonisof • Leukotrienreseptorantagonisof • Teofillien • Oralekortikosteroïede (prednisoon)

  42. Important considerations - RxBelangrikedingeomteoorweeg - Rx • Severity of asthma • Safety of drugs • Cost of drugs • Availability of drugs • Patient’s preference • Erns van asma • Middelveiligheid • Koste van middels • Beskikbaarheid van middels • Pasiënt se voorkeur

More Related