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Asthma in Children

Asthma in Children. Dr Rashmi Gaekwad ST3 7/11/12. Background. UK- highest prevalance rate for Asthma 1:13-adults, 1:8 children Numbers increased in last 4 decades Majority develop symptoms before 5 y

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Asthma in Children

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  1. Asthma in Children Dr Rashmi Gaekwad ST3 7/11/12

  2. Background • UK- highest prevalance rate for Asthma • 1:13-adults, 1:8 children • Numbers increased in last 4 decades • Majority develop symptoms before 5 y • Children with more severe asthma during school years-severe asthmatics in adult life

  3. High probability of asthma • Wheeze, cough, chest tightness, difficulty in breathing-frequent and recurrent, worse at night/exercise. • History of Atopic disorder-eczema, allergic rhinits • F/H of atopic disorder • Wheeze on auscultation • h/o improvement in symptoms/Lung function in response to adequate therapy • Diagnosis of Asthma

  4. Lower probability of Asthma • Only colds • Isolated cough • Normal chest exam-symptomatic • Normal PF/ Spirometry-symptomatic • No response to trial of asthma therapy • Diagnosis other than Asthma • Detailed Investigation/Specialist Referral

  5. Non-pharmacological Rx • Primary- BF, Avoidance of Tobacco smoke, weight reduction-obese • Secondary- exposure to allergen (carpets/pillow), furry pets, Parents to stop smoking, Buteyko Breathing Technique

  6. Acute Asthma • Acute Severe • SpO2<92%, PEF-33-50% • Too breathless to talk or feed • Pulse >125(>5y) or >140 (2-5) • Respiration >30 (>5) or >40 (2-5)

  7. Life threatening • SpO2 <92% PEF <33-50% • Hypotension • Silent chest • Exhaustion • Confusion • Cyanosis • Poor respiratory effort

  8. Criteria for admission • Beta-2 Agonist- 2 puffs every 2 min-10 puffs- not improved-transfer with nebs/O2 • Severe and life threatening-transfer to hospital

  9. Goals-therapy • No day time symptoms • Reduce no of acute exacerbation • No night time awakening-due to asthma • No need for rescue medication • No limitations on physical activity • Normal lung function FEV1>80% • Reduce Absences from school

  10. Long term mgmt • Inhaled Corticosteroids-best option-monotherapy. • Leukotriene Receptor Antagonist-alternative • Long acting Beta2 Agonist –not for maintenance monotherapy

  11. Mgmt • Prednisolone -20mg(2-5),30-40mg (>5)-3days(weaningif >14days) • Beta-2 Agonist+Ipratropium • Aminophylline-HDU/PICU

  12. Under 2 years • Assessment of acute asthma difficult. • Intermittent wheezing- viral infection • Response to asthma medication- inconsistent • DD-aspiration pneumonia, brochiolitis, tracheomalacia, CF, congenital anomalies • Prematurity and LBW-risk factor for recurrent wheezing

  13. Drug Delivery devices • Pressurised MDI+spacer+mask-3yrs • pMDI+spacer-3-5yrs • Dry powder inhalers->5yrs • Breath actuated inhalers- older children

  14. Primary care • Reviewed by Nurse or Doctor • Incorporate a written action plan • Maintain a Register • Patient education-self –mgmt shown to improve health outcomes.

  15. Bottom line • Childhood Asthma –clinical diagnosis, >6y objective measures- confirm • Inhaled steroids-controller • A/E-good discharge plan-reduce admission • Good self mgmt plan-reliever, controller, acute

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