asthma in children my presentation

8/11/2019 Asthma in Children My Presentation

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Asthma in Children

Mohd Afiq Mastuki


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Overview Definition Prevalence Pathophysiology Diagnosis Physical signs and symptoms Investigation Treatment

Follow-up Asthma in adolescence Asthma Action Plan


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What is Asthma? Chronic airway inflammation leading to

increased airway responsiveness thatleads to: recurrent episodes of wheezing, breathlessness, chest tightness coughing,

particularly at night or early morning. often associated with airflow obstruction


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Asthma is one of the most common chronicdiseases worldwide with an estimated 300million affected individuals

Prevalence increasing in many countries,especially in children

A major cause of school/work absence


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Prevalence in Malaysia In primary school children is reported as 13.8%; In children aged 13-14 years it is 9.6% The prevalence of self-reported asthma in adults as

reported in a Ministry of Health Third NationalHealth and Morbidity Survey is 4.1%.

In the same study, the Chinese recordedsignificantly lower prevalence of asthma (2.4%)than other races (5.6%)

[source: national health and morbidity survey (NHMS3) 2006]


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Source: Peter J.Barnes, MD

Environmental factors Genetic predisposition

Bronchial inflammation (eosinophils, neutrophils, lymphocytes, mast cells,mediators, cytokines)

Bronchial hyperactivity + trigger factors

Oedema, Bronchoconstriction, Increasedmucus production

Airways narrowing

Symptoms: cough, wheeze,breathlessness, chest tightness


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Precipitants of asthmatic attack

Animal with fur Domestic dust mites Pollen Exercise Dust Smoke Respiratory Tract

Infection Strong emotional

expression Aerosol chemicals

Cold weather Cold drinks Certain food/fruits And many others


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Diagnosing Asthma:Medical History

Symptoms Coughing Wheezing Shortness of breath

Chest tightness Symptom Patterns Severity

Family History


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Diagnosing Asthma Troublesome cough, particularly at night Awakened by coughing Coughing or wheezing after physical

activity Breathing problems during particular

seasons Coughing, wheezing, or chest tightness

after allergen exposure Colds that last more than 10 days

Relief when medication is used


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Wheezing sounds during normal breathing Hyperexpansion of the thorax Increased nasal secretions or nasal polyps

Atopic dermatitis, eczema, or other allergicskin conditions


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Physical ExaminationSigns of chronic illness

Harrison sulci (indrawing of the ribs, forming symmetricalhorizontal grooves above the costal margins) hyperinated chest eczema / dry skin hypertrophied turbinates

Signs in acute exacerbation tachypnoea expiratory wheeze, rhonchi, prolonged expiratory phase

hyperinated chest accessory muscles cyanosis drowsiness tachycardia


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Classification of severity of Asthma


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INVESTIGATIONS Full Blood Count Arterial blood gases

For acute severe asthma Chest X-ray

Ordered if there is suspicion of complications, e.g.pneumonia, pneumothorax or collapse.

PEFR (pre and post neb)


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Medications to Treat Asthma

Medicationscome in severalforms.

Two majorcategories ofmedications are:

Long-termcontrol Quick relief


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The choice of treatment should be guided by: Level of asthma control Current treatment Pharmacological properties and availability

of the various forms of asthma treatment Economic considerations


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Medications to Treat Asthma:Long-Term Control

Taken daily over a long period of time Used to reduce inflammation, relax airway

muscles, and improve symptoms and lungfunction

Inhaled corticosteroids Long-acting beta 2-agonists Leukotriene modifiers


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Medications to Treat Asthma:How to Use a Spray Inhaler

The health-careprovider shouldevaluate inhalertechnique at eachvisit.

Source: What You and Your Family Can Do About Asthma by the Global Initiative for Asthma Createdand funded by NIH/NHLBI


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Medications to Treat Asthma:Inhalers and Spacers

Spacers can helppatients who have

difficulty with inhaleruse and can reducepotential for adverseeffects frommedication.


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Medications to Treat Asthma:Nebulizer

Machine produces amist of the medicationUsed for small children

or for severe asthmaepisodesNo evidence that it ismore effective than an

inhaler used with aspacer


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Drug Doses for Asthma


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SUMMARY OF TREATMENT IN CHILDREN < 5 YRS OLD


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SUMMARY OF TREATMENT IN CHILDREN < 5 YRS OLD


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SUMMARY OF TREATMENT IN CHILDREN 5-12 YRS OLD


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Clinical Control of Asthma Determine the initial level of control toimplement treatment (assess patientimpairment)

Maintain control once treatment has beenimplemented (assess patient risk)


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Levels of Asthma Control(Assess patient impairment)


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Assess Patient Risk Features that are associated with increased

risk of adverse events in the future include:

Poor clinical control

Frequent exacerbations in past year

Ever admission to critical care for asthma

Low FEV1, exposure to cigarette smoke,high dose medications


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Factors Involved in Non-Adherence

Medication

Difficulties associated withinhalers

Complicated regimens

Fears about, or actual sideeffects

Cost

Distance to pharmacies

Non-Medication Factors

Misunderstanding/lack ofinformation

Fears about side-effects

Inappropriate expectations

Underestimation of severity

Attitudes toward ill health

Cultural factors

Poor communication


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ACUTE ASTHMA

The Initial Assessment in Management


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The Initial Assessment in Managementof Acute Asthma


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Criteria of Admission failure to respond to standard home

treatment failure of those with mild or moderate acute

asthma to respond to nebulised -agonists relapse within 4 hours of nebulised -

agonists severe acute asthma

f


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Management of Acute AsthmaInitial (Acute assessment)1. Diagnosis- symptoms e.g. cough, wheezing.

breathlessness , pneumonia2. Triggering factors - food, weather, exercise,

infection, emotion, drugs, aeroallergens3. Severity - respiratory rate, colour, respiratory

effort, conscious level

d


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Management Considerations monitor pulse, colour, PEFR, ABG and SpO . Close monitoring for at

least 4 hours. hydration - give maintenance uids . role of aminophylline debated due to its potential toxicity. To be

used with caution. antibiotics indicated only if bacterial infection suspected. avoid sedatives and mucolytics. efficacy of prednisolone in the rst year of life is poor. on discharge, patients must be provided with an Asthma Action

Plan to assist parents or patients to prevent/terminate asthma attacks. The plan

must include: how to recognize worsening asthma how to treat worsening asthma how & when to seek medical attention

Algorithm for Management of Acute


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Algorithm for Management of AcuteAsthma

D D f A A h


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Drug Doses for Acute Asthma

P i


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PreventionIdentifying and avoiding the following common triggers may be useful1. environmental allergens

These include house dust mites, animal dander, insects likecockroach, mould and pollen.

Useful measures include damp dusting, frequent laundering ofbedding with hot water,

encasing pillow and mattresses with plastic/vinyl covers, removalof carpets from bedrooms, frequent vacuuming and removal ofpets from the household.

2. cigarette smoke3. respiratory tract infections - commonest trigger in children.4. food allergy - uncommon trigger, occurring in 1-2% of children

5. exercise Although it is a recognised trigger, activity should not be limited.

Taking a -agonist prior to strenuous exercise, as well asoptimizing treatment, are usually hepful.

ASTHMA ACTION PLAN


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ASTHMA ACTION PLAN An action plan is a personalised plan for the patient

to manage his asthma himself. It should be discussed and agreed upon by the

medical caregiver and the patient and is based onsymptoms and/or peak flow measurement.

It should ideally be written rather than verbal. Anaction plan helps the patient to recognise and actupon symptoms without having to wait for a medicalconsultation.

It may be based on a traffic lights system.


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AMBER ZONE


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AMBER ZONE


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Serangan asma

4 semburan ubat pelega

Pernafasan tidakbertambah baik

Ulang 4 semburan ubatpelega

Pernafasan masih tidakbertambah baik

Pernafasan bertambahbaik

Bagi4 semburan 4jam sekali untuk 1 hari,kemudian 6 jam sekali 1 hari,8 jam sekali 1 hari,Kemudian guna masih perlu jikapernafasan tetap elok.

Serangan asma berulang-ulangHANTARHOSPITAL !

FOLLOW UP
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FOLLOW UP Before discharge from ward parents/ caregiver

should receive Asthma education

Instruction on recognition signs of recurrence andworsening asthma

Determination and avoidance of the precipitant factors Asthmatic diary

Supply of the metered dose inhaler Careful review of the inhaler technique Appointment of further follow up.

A t d i g F ll U


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Assessment during Follow Up1. assess severity

2. response to therapy interval symptoms frequency and severity of acute exacerba on morbidity secondary to asthma quality of life PEF monitoring on each visit

3. compliance frequency and technique, reason and excuses

4. education technique, factual information, written action plan, PEF

monitoring may not be practical for all asthmatics but isessential especially for those have poor perception ofsymptoms and those with life threatening attacks

A th DiAsthma Diary


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Asthma DiaryTarikh/Hari Masa Gejala Punca Tindakan ibu Kesan

BatukNafas berbunyiHidung kembangRuamSelsemaKahakDemam

Air condSejuk pagiHujanBalik dari luar

Ubat pam salbutamolSapu vicks di dada

OkTak Ok


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1. Ubat pam- Coklat (Budesonide) Pagi 1 pam Malam 1 pam2. Biru (Salbutamol) 4 pam Tiap-tiap 4 jam untuk 3 hari Tiap-tiap 6 jam untuk 3 hari

Tiap-tiap 8 jam untuk 3 hari Bila perlu

MDI WITH AEROCHAMBER


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MDI WITH AEROCHAMBER

Cleaning theAeroChamber:

Powder collects in theAeroChamber and around

the Flow Indicator Valve.This should be cleanedwell at least once a week.

Wash the mouthpieceand AeroChamber once aweek.

Steps to follow to clean: Place in sink with warm

soapy water. Gently shake the

AeroChamber to loosenparticles.

Place in clear water torinse soap off.

Shake gently, placeupright on a clean cloth

or paper towel. Air dry.


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THANK YOU

asthma in children my presentation

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