Paediatric Asthma

Maria TraceyPaediatric Pharmacist

Jane DavisPaediatric 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

2

Definition of asthmaDefinition of asthma

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

“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.”

Statistics

• 5.2 million people in UK

• 1.1 million children

What is Asthma?

• Or a combination of all three

Swelling Inflammation Excess mucus

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

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

• Relievers

• Preventers

• Additional Treatments

Asthma Medications

Easyhaler

Overview: Inhaler devicesOverview: Inhaler devices

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

•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

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 asthmaSummary: 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 aged0-5 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