Paediatric Asthma Maria Tracey Paediatric Pharmacist Jane Davis

Paediatric Asthma Maria Tracey Paediatric Pharmacist Jane Davis Paediatric 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

Statistics • 5. 2 million people in UK (390, 000 people in Scotland) • 1. 1 million children(100, 000 in Scotland 1 in 9 of the total population are children)

What is Asthma? Asthma is a condition of the airways where there is difficulty in breathing due to Inflammation • Swelling Excess mucus Or a combination of all three

Asthma Triggers • Infections (eg colds and viruses) • House-dust mite • Pets (furred / feathered) • Second hand smoke • Exercise • Pollens/moulds

How Does Asthma Feel? “Being strangled without the hands around your neck” “It feels like someone has put a ten-ton stack of bricks on your chest” “You take a huge bucket of air but can only take a spoonful down”

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

Children Less than 5 yrs

Children Less than 5 yrs

Children Less than 5 yrs

Children Less than 5 yrs

Children Less than 5 yrs

Asthma Medications • Relievers • Preventers • Additional Treatments

Easyhaler

Overview: Inhaler devices • p. MDI + spacer is preferred delivery method in children aged 0 -5 years • p. MDI + 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 Inhaler devices. Thorax 2003; 58 (Suppl I): i 1 -i 92

Multidosing • Multiple puffs(up to 10) of a short-acting ß 2 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 p. MDI + spacer with doses titrated according to clinical response

Summary: Paediatric asthma • Inhaled steroids are the recommended preventer drug • In children >5 years, add inhaled long acting ß 2 agonists rather than increasing the dose of inhaled steroids above 400 mcg/day • p. MDI + spacer is preferred delivery method in children aged 0 -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 1 V