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- PEFR is reliably measure children > 5 yo
Stepwise management of asthma:-
- Effective TX with inhaled drugs depends
Step 1 – mild SABA – salbutamol or on having the right type of inhaler for each
intermittent asthma terbutaline child. In younger
Step 2 – regular Add twice daily inhaled
preventer therapy corticosteroid eg: - Children the best drug delivery us
fluticasone, achieved by metered –dose-inhaler and a
beclomethasone, spacer. A face mask can be attached to the
budesonide spacer for children under 2 years old.
Step 3 – ADD ON Consider high dose of
THERAPY steroid or adding LABA
(eg. salmeterol) or - Dry powder inhalers such as turbohaler
monterlukast (might can be used for those over 5 as they are
benefit in some patient) more portable than spacer
- LABA and inhaled
corticosteroid are - Many parents are concern about the side
available in effects of long-term steroid therapy. Side
combined inhalers. effects from inhaled steroids are unlikely
at low doses. Patients grow properly if the
Step 4 – Persistent High dose of
asthma is properly controlled even with
poor control steroid & LABA
steroids. Higher steroids doses can cause
If sx is poorly
impaired growth and osteoporosis but this
controlled –
is rarely seen. Oral candidiasis is more
consider
common and children should be taught to
anticholinergics
wash their mouth after taking inhaler.
- Inhaled –
ipratropium
- As children enter their teens they have to
bromide
take more responsibility for the
- Oral – theophylline
management of long term conditions. This
requires a constructive approach
Step 5 – continuous Oral prednisolone
minimising the impact of the disease and
or frequent use of
its treatment on their lives
steroid