Transcript Respiratory Disease in Children

Paediatric Asthma
26th November 2014
Julie Westwood
Asthma Nurse Specialist
RHSC
0131 536 0773
Topics to explore
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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:
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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
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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 day
3-4 years 30mg once per day
5 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’s
4 puffs
4 times a day
4 days
Acute attack
10 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
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Jonathan Grigg, M.D., F.R.C.P.C.H.
n engl j med 360;4 nejm.org January 22, 2009
., and
• 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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