paediatric asthma 26 th november 2014 julie westwood asthma nurse specialist rhsc 0131 536 0773

Paediatric Asthma

26th November 2014Julie Westwood

Asthma Nurse SpecialistRHSC

0131 536 0773

Topics to explore

• Normal childhood• Diagnosing asthma in children• Considering the probability• Treatment

Normal Childhood

Some facts

<2 years of age– Average of 12 URTIs (colds) per year– Cough can last for up to 14 days with

each cold (i.e. up to 24 weeks cough/yr)

<6 years of age– 50% of children will have had at least

one episode of wheeze (c10% have asthma) I.e. almost normal to wheeze

Asthma in children

• SIGN/BTS Guideline October 2014 (online) 141

• Diagnosis by probability (introduced 2008)

• Adolescent section• Supersedes 101

Probability

Asthma in children - high probability

• > 1 of: wheeze, cough, difficulty breathing, chest tightness esp if:– Frequent and recurrent– Worse at night / early morning– In response to triggers– Occur apart from colds

• Personal history of atopic disorders• Family history of atopic disorder/asthma • Widespread wheeze heard on auscultation• History of improvement in symptoms or lung

function in response to adequate treatment

Asthma in children - low probability

• Symptom with URTI only – with no interval symptoms

• Isolated cough in the absence of wheeze or difficulty breathing

• History of moist cough• Prominent dizziness, light headedness or

peripheral tingling• Repeatedly normal physical examination of chest

when symptomatic• Normal PEF/Spirometry when symptomatic• No response to trial of asthma therapy• Clinical features pointing to alternative diagnosis

Asthma in children - intermediate probability

• In between the two!• Try reversibility – using PEFR• Trial of treatment• Ensuring appropriate devices and

explanation of medication use• Consider other testing but ? not

appropriate in primary care (exercise testing, allergy testing)

Asthma treatment in children

Prescribing for an acute asthma exacerbation in children

• Oral Prednisolone• 3 day course• Prescribe according to age

<12 months (2mg/kg once per day)1-2 years 20mg once per day3-4 years 30mg once per day5 years 40mg once per day(reducing course should be given, if previous 3 day course

in past month)

Prescribing for an acute asthma exacerbation in children in any

age group

Increased Bronchodilator: Salbutamol - remember the

4’s4 puffs4 times a day4 days

Acute attack10 puffs Salbutamol through

Spacer – no more than 2 multi doses within 24hrs without review

Please consider….

• Oral Prednisolone for Preschool Children with Acute Virus-Induced Wheezing

• Jayachandran Panickar, M.D., M.R.C.P.C.H., Monica Lakhanpaul, M.D., F.R.C.P.C.H., Paul C. Lambert, Ph.D.,

• Priti Kenia, M.B., B.S., M.R.C.P.C.H., Terence Stephenson,

D.M., F.R.C.P.C.H., Alan Smyth, M.D., F.R.C.P.C.H., and Jonathan Grigg, M.D., F.R.C.P.C.H.

• n engl j med 360;4 nejm.org January 22, 2009

• Viral wheeze is common• Conventional ‘asthma’ treatments

may not be effective• Caution – repeated oral steroid

prescribing without perceived day 1 response

• Limited effect from inhaled steroids• Is Montelukast a good alternative?

ACUTE PRE-SCHOOL WHEEZE– Montelukast may shorten duration of

symptoms around colds and respiratory viruses

– Some suggestion of acute reduction in trouble breathing in association with infections

Bacharier J Allergy Clin Immunol 2008

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