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Asthma



What is Asthma?

Asthma is a condition where the breathing tubes can narrow causing wheeze and difficulty in breathing. This is called “reversible hypersensitivity”.  The wheezy noise is produced by the rapid movement of air through a narrow channel making noise due to air turbulence in the same way that a whistle makes a noise.

Signs & symptoms

The following symptoms are suggestive of asthma:

  • Wheeze,
  • Cough,
  • Difficulty breathing,
  • Chest tightness (which may be worse at night or in the early morning)

The above may occur in response to, or be worse after exercise or other triggers (e.g. pets, exposure to cold or damp air).

Other features, which increase the likelihood of a diagnosis of asthma, include:

  • Personal history of atopy
  • Family history of atopy and/or asthma
  • Widespread wheeze heard on auscultation
  • History of improvement in symptoms or lung function in response to treatment.

Treatment

Asthma can be managed using a range of drugs that can help your child breathe more easily.

The medicines used to treat asthma can be divided into 2 main groups;

  1. Relief medication
  2. Preventer medication

Relief medication is used to treat an acute attack of asthma. Relief treatment helps the airways to relax and open up, making it easier to breathe. There are a number of medicines that can be used when symptoms start to worsen (increased cough, wheeze or shortness of breath). It is important to learn how to manage your asthma so that you can not only prevent attacks but also predict when you need to increase your treatment.

Your GP or paediatrician will prescribe a combination of medication which will usually include a relief medication along with some preventer medication.

Common relief medication

  1. Salbutamol (also known as Ventolin)
  2. Terbutaline (also known as Bricanyl)
  3. Ipatropium bromide (also known as Atrovent)
  4. Salmeterol (also known as Serevent)-This is a long acting drug that is given 12 hourly
  5. Formoterol fumerate (also known as Oxis)- This is a long acting drug that is given 12 hourly

In the UK, salbutamol is one of the most commonly used inhalers. It usually comes as a blue inhaler and once given begins to become effective after 10 minutes. It’s effects may last upto 4 hours but sometimes it has to be given more frequently, particulalrly if the child is struggling to breathe. This will be covered in more detail in the “Emergency treatment” section. It’s important to get the relief treatment in early, before the symptoms become too severe.

Common preventer medication

  1. Budesonide (also known as Pulmicort)
  2. Beclometasone Dirpopionate (also known as Clenil)
  3. Fluticasone (also known as Flixotide)
  4. Sodium cromoglycate (also known as Intal)
  5. Nedocromil sodium (also known as Tilade)
  6. Montelukast (also known as Singulair)

Combination medication

Sometimes medicines are combined into one device to make it easier for the patient to manage their symptoms. Examples of combined medication include:

  1. Seretide (Serevent & Flixotide)
  2. Symbicort (Budesonide & Formoterol fumerate)

Leukotriene Receptor Antagonists

The leukotriene receptor antagonists, Montelukast & Zafirlukast can be used in children with chronic asthma either alongside an inhaled steroid or instead of an inhaled steroid if this cannot be used. An inhaled steroid with a leukotriene receptor antagonist appears to be a particularly effective combination. These medicines are given as either granules or tablets.

Anti-histamines

In patients where there is a clear allergic component to their asthma, an anti-histamine such as cetirizine or loratadine might be useful.

Steroid tablets

If a child with asthma is unwell enough to attend hospital, they will usually be given a short 3 day course of steroids . Steroids help to reduce the inflammation in the airways therfore making it easier to breathe.

Omalizumab

Omalizumab is a type of drug known as a monoclonal antibody. It is used in severe persistent allergic asthma in children over 6 years of age who have requred frequent treatment with steroid tablets (4 or more courses within a year).

How is treatment given?

The commonest method of drug administration in children is to use a metered dose inhaler (known as a MDI) together with a spacer device such as a volumatic or aerochamber. It is extremely important that the spacer and MDI are used in the correct way as this determines how much medicine gets into the airways and lungs where they are needed.

Spacers

Spacers help the delivery of medicine to the airways & lungs of a child with asthma by making it easier to inhale the medicines and making sure they get to where they are needed.

There are different types of spacers available including volumatics,nebuhalers and aerochambers. The different spacers have different characteristics but all try to improve the delivery of medicine to the chest of children with asthma.

Before you use a spacer for the first time it’s important to wash in warm soapy water and allow to drip dry (do not rub it dry using towels). This reduces the amount of static electricity on the inside of the spacer and therefore improves the delivery of medicines.

Using spacers in the correct way with metered dose inhalers (MDI’s) helps to optimise the delivery of medicine to the chest of patients with asthma.

The following videos show how to use a spacer with an MDI in a child.

How to use a small volume spacer with a child

How to use a large volume spacer with a child

Sometimes treatment needs to be given using a nebuliser. This involves giving a higher dose of medication in an aerosoled form through a mask. Nebulisers are usually needed if a child with asthma is particulalrly unwell and struggling with using spacers to get their medication into their airways.

Preventing attacks

In order to prevent an attack it is important to take preventer & relief treatment as prescribed by your doctor or asthma nurse. How well the lungs and airways are functioning in an asthmatic patient can be measured using a peak flow meter. This is a measure of how fast and hard a patient can breathe out. Most asthma patients will have a “predicted” peak flow that is dependent on how tall you are. This is the peak flow that you should be able to achieve for your height. Click on the following link to see what your child’s predicted peak flow is: Predicted Peak Flow.

Some asthma patients learn what their “best peak flow” is over time and use this as a baseline. By measuring your peak flow regularly you can learn to predict when your symptoms are likely to deteriorate and therefore increase your medication as outlined in your asthma treatment plan. There are different types of asthma treatment plans available, the one connected to the following link has been developed by Asthma UK: Children’s Asthma Treatment Plan . It is important for you to complete and understand your child’s treatment plan with the asthma nurse or doctor so that you know what to do if your child’s symptoms escalate and you also know who to contact for advice.

  • Emergency Treatment
  • Relief Treatment
  • Preventer Treatment
  • Using a Small Spacer
  • Using a Large Spacer

If your child is a known asthmatic and is very unwell with shortness of breath, coughing or wheeze then you can give 10 puffs of the blue inhaler (salbutamol)  through the spacer. Each puff should be given individually with the child breathing in and out for 30 seconds or 10 breaths through the spacer.

Ensure that there is at least 30 seconds between each puff being given as this allows the chamber in the inhaler to fill.

If your child is very unwell you will need to call 999. If you think there has been some improvement you may be able to take them straight to A+E

If you do have to call an ambulance you can continue to adminster salbutamol by giving a further 10 puffs as above whilst you are waiting, if you feel this is needed.

Common relief medication

  1. Salbutamol (also known as Ventolin)
  2. Terbutaline (also known as Bricanyl)
  3. Ipatropium bromide (also known as Atrovent)
  4. Salmeterol (also known as Serevent)-This is a long acting drug that is given 12 hourly
  5. Formoterol fumerate (also known as Oxis)- This is a long acting drug that is given 12 hourly

In the UK, salbutamol is one of the most commonly used inhalers. It usually comes as a blue inhaler and once given begins to become effective after 10 minutes. It’s effects may last upto 4 hours but sometimes it has to be given more frequently, particulalrly if the child is struggling to breathe. This will be covered in more detail in the “Emergency treatment” section.

Common preventer medication

  1. Budesonide (also known as Pulmicort)
  2. Beclometasone Dirpopionate (also known as Clenil)
  3. Fluticasone (also known as Flixotide)
  4. Sodium cromoglycate (also known as Intal)
  5. Nedocromil sodium (also known as Tilade)
  6. Montelukast (also known as Singulair)

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