Tag Archives: asthma

October 2014 published

October 2014 holds quite a few topics: scalp ringworm, sleep and behaviour, support for victims of sexual abuse, immunotherapy for peanut allergy, link to parental asthma booklet and what to do with babies with chicken pox.  Do leave comments below…

January 2012 PDF ready

Do you know your valgus from your varus?  Or your myclonic epilepsy from your sleep myoclonus?  A link this month to new asthma patient information leaflets and some reminders of NICE’s “Do not do recommendations” in feverish children.  Also the BSACI egg allergy guideline.  Do leave comments on any of these topics below.

June 2011 for ED clinicians

A move away from NICE guidelines this month to cover the 2011 BTS/SIGN asthma guidelines and a link to a succinct summary of the current UK immunisation schedule written by one of our registrars.  Also a bit from the literature on management of gastro-oesophageal reflux disease and a few pointers about Forced Marriage which is an important safeguarding issue in our region.  Do leave comments.

Childhood Peak Expiratory Flow Rates (PEFR)

Children from about 5 years old may be able to use a Peak Flow Meter to record their PEFR. As one of the parameters by which we diagnose a severe or life-threatening asthma exacerbation is the percentage drop in PEFR, it would help to know what a child’s normal PEFR is! Click here for a guide of what you might expect for height. Children don’t always conform to these norms so it is important to know what the child’s own normal PEFR is; a 20% drop in their norm suggests poor control of asthma, a 40% drop suggests a significant exacerbation.

January GP edition here!

January reminds us all of the NICE guideline on head injury and specifically when a child is supposed to be referred for a CT.  We continue our 6-8 week baby check series with information on undescended testes.  There are also links to agreed blood test reference ranges and resources to help with the identification of asthma inhalers.  Download January 2011 GP PDF here.

Inhalers for asthma

Most families in the Emergency Department will talk about their child’s “blue” and “brown” inhaler.  Can we, or they, tell which is the reliever and which the preventer? 

 Click here for a printable table of some common inhalers listed by colour.  I have also found a very useful site put together by a pharmacist and a medical student with photos of lots of the inhalers so you can get your patient to identify which one they are on.  Take a look at http://www.rch.org.au/clinicalguide/asthmadevices/

 Device   Comments
Standard metered dose inhaler (MDI)
  • Children < 12 years old unlikely to be able to use it properly without a spacer
  • Small, conveniently pocket-sized
  • Requires shaking and priming
  • Not affected by humidity
MDI and spacer
  • Bulky
  • Better delivery of drug at all ages
  • NICE suggests < 5 years, all inhalers should be given with a spacer device and 5-15 years, at least the corticosteroids should be given with a spacer
Dry powder device
  • Children < 6 years old generally can not use it as it requires a fast, deep breath to activate it
  • Medicine can be blown away if child accidentally breathes out
  • Clearer when the medicine is running out than the MDI
  • Single dose models require loading of capsules for each use
  • Powder sticks together if high humidity

 

http://www.asthma.org.uk/health_professionals/materials_to_help_you_your_patients/index.html has a link to a comprehensive information leaflet for young people over the age of 12 who need to take control of their asthma management and understand their condition.

http://www.nice.org.uk/nicemedia/live/11400/32073/32073.pdf  is the 2000 guideline on asthma management in the < 5 year olds

http://www.nice.org.uk/guidance/index.jsp?action=byID&r=true&o=11450 is the 2002 guideline for 5-15 year olds