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Aims of long term asthma treatment in children
MCQ exam: clinical scenario
MCQ exam: answers
MCQ exam: explanation
Aims of long term asthma treatment in children
The aim of treatment is to achieve control of asthma. Complete control of asthma is defined as no daytime symptoms, no night-time awakening due to asthma, no asthma attacks, no need for rescue medication, no limitations on activity including exercise, normal lung function (in practical terms forced expiratory volume in 1 second (FEV1) and/or peak expiratory flow (PEF) > 80% predicted or best), and minimal side-effects from treatment.For children aged over 5 years, NICE (2017) treatment recommendations for children apply to children aged 5–16 years, and adult treatment recommendations apply to those aged 17 years and over. Whereas, for children aged over 5 years, BTS/SIGN (2019) treatment recommendations for children apply to children aged 5–12 years, and adult treatment recommendations apply to those aged over 12 years.
MCQ exam: clinical scenario
An 8 year old boy is newly diagnosed with asthma and is initially treated with nedocromil sodium.Eight weeks after starting treatment he is seen at the outpatient clinic. His mother complains that her son has remained symptomatic with persistent breathing difficulties and wheezing with physical activity and occasionally complains of tightness in the chest. He has lost four days of school in this period for this reason.
Appropriate treatment at this stage should include:
a) No medical treatment required
b) Nebulised ipratropium bromide
c) Single dose 1 ml 0.5% salbutamol
d) inhaled low dose corticosteroids
e) refer to an ENT specialist
MCQ exam: answers
The correct answer is D.With the scenario above, inhaled low dose corticosteroids must be included.
MCQ exam: explanations
For children with symptomatic disease and an impaired quality of life, inhaled corticosteroids are, and should remain, the mainstay of asthma control.Start intermittent reliever therapy with an inhaled short-acting beta2 agonist (such as salbutamol or terbutaline sulfate), to be used as required in all children with asthma. For those with infrequent short-lived wheeze, occasional use of reliever therapy may be the only treatment required. Children using more than one short-acting beta2 agonist inhaler device a month should have their asthma urgently assessed and action taken to improve poorly controlled asthma.
If they remain symptomatic and/or quality of life impaired, then regular preventer (also called maintenance) therapy should be initiated with inhaled corticosteroids, or inhaled corticosteroids as a component.
Reference(s)
1). British National Formulary (BNF): Asthma, chronic. Available online: https://bnf.nice.org.uk/treatment-summary/asthma-chronic.html
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