Asthma
Definition
Clinical Presentation
Triggers
Management
Acute - Home
Acute - Hospital
Chronic
Canadian Paediatric Asthma Consensus Guidelines for assessing adequate control of asthma:
Source
Toronto Notes 2012
www.rch.org.au 2014
- Reversible small airway obstruction due to atopy
Clinical Presentation
- Episodic bouts of
- Wheezing
- Dyspnoea
- Cough: at night, early morning, with activity, with cold exposure
- ↑ RR
Triggers
- URTI (viral or Mycoplasma)
- Weather (cold exposure, humidity changes)
- Allergens (pets), irritants (cigarette smoke)
- Exercise, emotional stress
- Drugs (aspirin, ~-blockers)
Management
Acute - Home
- 4*4 rule (4 puffs SABA, wait 4 min, then 4 puffs --> if ineffective, call for ambulance)
Acute - Hospital
- 0 2 to keep 0 2 saturation >92%
- Fluids if dehydrated
- SABA ß2-agonists: salbutamol (Ventolin'")
- 6 puffs <6y, 12 puffs >6y
- 1 dose of above, wait 20 min, repeat if no abatement. For 1 hour (aka hour of power)
- Ipratropium bromide (Atrovent'") if severe
- 4 puffs <6y, 8 puffs >6y
- Hour of power
- Steroids: Oral prednisone (2 mg/kg in ED, then 1 mg/kg daily x 4 d), IV methylpred (1mg/kg) or dexamethasone (0.3 mg/kg/d)
- In severe disease, give steroids immediately since onset of action is slow ( 4 h)
Chronic
- Education, emotional support, avoid allergens or irritants, develop an "action plan"
- Exercise program (e.g. swimming)
- Monitoring of respiratory function with peak flow meter (improves adherence and allows modification of medication)
- PFTs for children >6 yrs
- Reliever therapy: SABA (e.g. salbutamol)
- Preventer therapy: low dose daily inhaled corticosteroids (less than 200 meg dose of hydrofluroalkane (HFA) beclamethasone equivalent) are first line for children of all ages
- Leukotriene receptor antagonist monotherapy may be considered as an alternative 2nd line therapy in children of all ages
- For severe asthma unresponsive to first and second line treatments injection immunotherapy can be used
- Aerochamber for children using HFAs
Canadian Paediatric Asthma Consensus Guidelines for assessing adequate control of asthma:
- Daytime symptoms <4 d/wk
- Night time symptoms < 1 night/wk
- Normal physical activity
- Mild and infreqeunt exacerbations
- No work/school absenteeism
- Need for beta agonist <4 doses/wk
- FEV 1 or peak expiratory flow 2:90% of personal best
- Peak expiratory flow diurnal variation <10 to 15%
Source
Toronto Notes 2012
www.rch.org.au 2014