Key points
• A child’s pattern of asthma may help to predict whether
the child will “outgrow” the condition.
• Inhaled steroids are the controller medication of choice for
children.
• To be effective, inhaled steroids must be given regularly,
for at least a season at a time, not just during asthma
attacks.
• Leukotriene receptor antagonists may be useful for
asthma triggered by colds.
• Most children who are seen in the emergency department
can be given bronchodilator therapy with a metered-dose
inhaler and valved spacer.

Key points• A child’s pattern of asthma may help to predict whetherthe child will “outgrow” the condition.• Inhaled steroids are the controller medication of choice forchildren.• To be effective, inhaled steroids must be given regularly,for at least a season at a time, not just during asthmaattacks.• Leukotriene receptor antagonists may be useful forasthma triggered by colds.• Most children who are seen in the emergency departmentcan be given bronchodilator therapy with a metered-doseinhaler and valved spacer.

Achieving control of asthma in preschoolers

There is an interesting article in “Chest, Jun 2001; 119: 1913 – 1929.” by Heinrich A. Werner, MD which may serve as a refresher in the diagnosis and treatment of children (and adults) in Status Asthmaticus. Although the definition varies, Status Asthmaticus may be defined as a condition of a patient deteriorating into respiratory failure from asthma which becomes unresponsive to conventional treatment modalities such as bronchodilator therapy.
The article describes presenting signs and symptoms and goes on to indicate that degree of chest wheeze does not correlate with severity of illness. Pulsus paradoxsis was found to be an excellant prognosticator of severity of asthma attack and can be one of the variables to be followed to determine effacacy of treatment, so long as fatigue and decreased level of conscientious do not occur.

astma

The authour goes on to indicate that ABG’s should not be a basis for intubation, but rather be determined on clinical grounds.
Fluid replacment is important in the treatment of an asthmatic but NOT during an attack. Abics are not routinely considered as most attacks initiated by an infection are viral in nature.
During nebulizer therapy with a B-agonist such as salbutamol, the authour indicates that much less than 10% is depositied into the lung under ideal conditions. As a consequence he recommends an increase in dosage and a proper flow rate setting to optimize particulate size and depositon. (10-12 lpm for a particle size of 1-3 um).

Excellent education link

This educational series on combination therapy for asthma and COPD examines recent evidence and strategies for combining bronchodilators and inhaled corticosteroids in the management of asthma or COPD. The expert faculty will assess clinical data and provide insights on how they may translate to clinical practice in Canada.

Access site HERE

astraeducation

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