Download Asthma in children - Neonatal and Paediatric Pharmacists Group

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.”
2
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 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 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 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