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Asthma SEVERITY

The most common chronic respiratory - Frequency of attack?


problem in childhood - Amount of disturbance to everyday life
(6/12) - schooling, sleeping, sport (SSS)
o 10-15% in school children etc.
- Previous treatment- appropriateness and
DEF: Reversible, chronic airway narrowing technique response#
involving 3 things:- - Symptoms free episodes (when was the
longest sx free episodes)
o Bronchoconstriction
o Chronic airway inflammation Investigations:
o Mucosal hypersecretion 1. Peak flow expiratory rate –
a. Diagnostically – a reduced peak
flow but responding to
bronchodilators is highly
suggestive of asthma.
b. usually shows diurnal variation
(evening is better than
morning) and patient can use
Peak flow to help them decides
when to use bronchodilators or
when to seek medical help
2. Chest x-ray
a. Normal in asthma
b. The only time it frequent
influence management of
asthma when there is
background infection (to
exclude pneumonia) and
Aetiology
pneumothorax
Environmental Genetic 3. Skin prick test / RAST
- Animal - ATOPY ( The a. Usually in atopy
dander tendency to b. Only useful if there is likely
- Emotion produce excessive allergen that could be removed
(laughing) IgE against or reduced identified
- Cold common allergens) 4. Sweat test/Immune test – cystic
weather - Eg: Hayfever, fibrosis
- Exercise eczema, asthma,
- Cigarette urticarial reaction, Management
smoking food allergy - It is important to recognise severe and life
threteaning asthma attack

Severe attack Life threatening attacks


Clinical features
- Unable to - Cyanosis, silent chest,
- Wheeze complete a feeble respiratory effort
- Chest tightness sentence in 1
- Dry cough (nocturnal) breath
- Shortness of breath - Tachypnoeic > 30 - Bradycardia /
- Tachycardic hypotension
>120bpm - Drowsy - hypercapnia

- PEFR < 50% - PEFR < 33% predicted


predicted
Acute management
- Immediate Life threatening:-
- ABC  Consider ABG and CXR
o Give 100% O2 using mask  Salbutamol 15ug/kg i.v. or 200ug/ml
o Give 2.5 mg salbutamol solution over 10 min
 Repeat 2.5mg nebulised salbutamol
nebulised with O2
 0.25 mg nebulised ipratropium bromide
o Oral prednisolone – 1.2 mg/kg
 Monitor peak flow and O2 sats and
up to 40 mg transfer to PICU if poor response to tx

Comments
- 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

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