Paediatrics: Asthma: clinic management (2)

2021-03-04 12:00 AM

In this age group, a spacer device with an appropriate face mask is used, e.g. a small volume Aerochamber® or Ablespacer® which can take any inhaler; or a large volume Volumatic® or Nebuhaler®, which only fit certain inhalers.

Asthma: clinic management (2)

0–2yrs

In this age group, a spacer device with an appropriate face mask is used, e.g. a small volume Aerochamber® or Ablespacer® which can take any inhaler; or a large volume Volumatic® or Nebuhaler®, which only fit certain inhalers. Prophylactic therapy with inhaled steroids is more effective than cromoglicate.

Acute treatment

  • Salbutamol via Volumatic®: <2400micrograms/day (in 6 doses).
  • Terbutaline via Nebuhaler®: <6000micrograms/day (in 6 doses).
  • Ipratropium via Volumatic®: <480micrograms/day (in 4 doses).

Prophylactic treatment

  • Budesonide via Nebuhaler®: 100–400micrograms/day.
  • Beclometasone via Volumatic®: 100–400micrograms/day.

3–5yrs

Acute treatment

  • Salbutamol via Volumatic®: <3600micrograms/day (in 6 doses).
  • Terbutaline via Nebuhaler®: <6000micrograms/day (in 6 doses).

Prophylactic treatment

  • Budesonide via Nebuhaler®: 100–800micrograms/day.
  • Beclomethasone via Volumatic®: 100–800micrograms/day.
  • Fluticasone via Volumatic®: (>4yrs) 100–200micrograms/day..
  • Salmeterol via Volumatic®: (>4yrs) 50micrograms/day. Must never be given alone and only when the child is also taking an inhaled steroid.
  • Combination inhaler: Seretide®(contains fixed doses of fluticasone and salmeterol).

5–12yrs

Acute treatment

  • Salbutamol Accuhaler®: <7200micrograms/day (in 6 doses).
  • Salbutamol inhaler: (>12 years) <7200micrograms/day (in 6 doses).
  • Terbutaline inhaler: (>12 years) <7200micrograms/day (in 6 doses).

Prophylactic treatment

  • Budesonide Turbohaler®: 100–800micrograms/day.
  • Beclometasone via Accuhaler®: 100–800micrograms/day.
  • Fluticasone via Volumatic®: 100–400micrograms/day.
  • Combination inhaler – Seretide®(contains fixed doses of fluticasone and salmeterol); or Symbicort turbohaler® (fixed doses of budesonide and formoterol).

 Useful clinic guides

Steroids

  • Fluticasone and budesonide are preferable since they have fewer side-effects than beclometasone
  • Patients on doses of steroids greater than fluticasone 500micrograms/day, budesonide 800micrograms/day, beclometasone 800micrograms/day should be under the supervision of a specialist clinic

Long-acting β2-agonists

  • Salmeterol may be of value for night-time symptoms or daytime activity
  • Should be used as a prophylactic agent
  • Consider in patients on inhaled beclomethasone or budesonide 400micrograms/day, or fluticasone 200micrograms/day

Allergen avoidance

  • Removal of feather or woollen bedding
  • Wrapping of mattress in plastic
  • Cleaning of carpets and furniture
  • No pets in the house if the child is allergic to them

Passive smoking

  • No smoking in the house or car.
  • Parents/carers must be strongly encouraged to stop smoking completely.

Education

Older patients will need to learn more about their condition and how it is best treated. For example:

  • Which medication to use and when
  • Best inhaler technique
  • What to do if asthma is getting worse
  • Not to smoke
  • Gargle after steroid inhaler use so as to avoid oral thrush