Paediatric Asthma

Maria Tracey Paediatric Pharmacist Jane Davis Paediatric 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

Definition of asthma

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.

Diagnosis and natural history. Thorax 2003; 58 (Suppl I): i1-i92

Statistics
5.2 million people in UK 1.1 million children

What is Asthma? Asthma is a condition of the airways where there is difficulty in breathing due to

Inflammation

Swelling

Excess mucus

Or a combination of all three

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

Asthma Medications

Relievers Preventers Additional Treatments

Easyhaler

Overview: Inhaler devices

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
Inhaler devices. Thorax 2003; 58 (Suppl I): i1-i92

Multidosing
Multiple puffs(up to 10) of a short-acting 2 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 asthma

Inhaled steroids are the recommended preventer drug In children >5 years, add inhaled long acting 2 agonists rather than increasing the dose of inhaled steroids above 400mcg/day pMDI + spacer is preferred delivery method in children aged 0-5 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