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Paediatric Asthma
Maria TraceyPaediatric Pharmacist
Jane DavisPaediatric Clinical Nurse Specialist
CF/Respiratory
Royal Alexandra Hospital Paisley
Objectives
• Explain the stepwise approach to the treatment of chronic asthma in children
• Demonstrate the choice of inhaler devices used in children
• Demonstrate multidosing
2
Definition of asthmaDefinition of asthma
Diagnosis and natural history. Thorax 2003; 58 (Suppl I): i1-i92
“A chronic inflammatory disorder of the airways …
in susceptible individuals, inflammatory symptoms
are usually associated with widespread but variable
airflow obstruction and an increase in airway
response to a variety of stimuli. Obstruction is often
reversible, either spontaneously or with treatment.”
Statistics
• 5.2 million people in UK
• 1.1 million children
What is Asthma?
• Or a combination of all three
Swelling Inflammation Excess mucus
Asthma is a condition of the airways where there is difficulty in breathing due to
Asthma Triggers
• Infections (eg colds and
viruses)
• House-dust mite
• Pets (furred / feathered)
• Second hand smoke
• Exercise
• Pollens/moulds
The Impact of Asthma
• Night cough, disturbed nights
• Restriction in activity / exercise
• Increased school absences
• Ongoing symptoms may have a detrimental effect on physical, psychological and social well-being
Children age 5-12 yrs
Children age 5-12 yrs
Children age 5-12 yrs
Children age 5-12 yrs
Children age 5-12 yrs
Children age 5-12 yrs
Combination Inhalers
• Steroid/LABA• Can improve compliance• Useful when asthma stable• Lack of flexibility to or dose
Key Points
• Dose equivalence of corticosteroids
• CFC free corticosteroid inhalers
• Accurate medication history
• Relievers
• Preventers
• Additional Treatments
Asthma Medications
Easyhaler
Overview: Inhaler devicesOverview: Inhaler devices
Inhaler devices. Thorax 2003; 58 (Suppl I): i1-i92
•pMDI + spacer is preferred delivery method in children aged 0-5 years
•pMDI + spacer is as effective as other delivery methods for other age groups
•Choice of inhaler should be based on patient preference and ability to use
Multidosing
• Multiple puffs(up to 10) of a short-acting ß2 agonist via a spacer device is as effective as nebulised
• Children(and adults) with mild and moderate exacerbation of asthma should be treated by bronchodilator given from a pMDI + spacer with doses titrated according to clinical response
Summary: Paediatric asthmaSummary: Paediatric asthma
• Inhaled steroids are the recommended preventer drug
• In children >5 years, add inhaled long acting ß2 agonists rather than increasing the dose of inhaled steroids above 400mcg/day
• pMDI + spacer is preferred delivery method in children aged0-5 years, and as effective as other delivery methods for other age groups
References
• www.Asthma.Org.Uk Tel 02077865000
• British Thoracic Society, Scottish Intercollegiate guidelines Network (2008) British Guideline on the Management of Asthma Thorax (63) Supplement 1V