Asthma – Children

Management has changed since 2016 when BTS (British Thoracic Society) updated their asthma guidelines.

 

Key Changes:

  • Previous numbered steps have been abandoned
  • All patients should receive an inhaled corticosteroid, right from the point of assessment in patients with suspected asthma

Management Approach

  1. Start treatment at the level most apporpriate to initial severity
  2. Achieve early control
  3. Maintain control by increasing treatment as necessary and decreasing treatment when control is good

First Step

  • Start a very low-dose inhaled corticosteroid (ICS) in all patients with a diagnosis or suspected diagnosis of asthma right from the “diagnosis and assessment period” prior to a formal diagnosis being made
  • All patients use a Short Acting Beta Agonist (SABA) as required
  • If the patient needs SABA more than three times a week then they need further add on therapy

Next Step

  • ≥5years: Add a long-acting beta agonist (LABA)
  • <5years: Add a leukotriene receptor antagonist

Long Acting Beta Agnoists Include

  •  Serevent Evohaler (Salmeterol),
  • Vertine Metered-Dose Inhaler (Salmeterol),
  • Formoterol Easyhaler (Formoterol),
  • Oxis Turbohaler (Formoterol)
  • Foradil Dry Powder Inhaler (Formoterol).

Leukotriene Receptor Antagonist: Include:

  • Montelukast (Singulair)

Next Step

Children Aged Over 5yrs

  • Depends on response to LABA (Serevent)
  • If no response to LABA – stop it and increase dose of ICS to low dose
  • If response to LABA – continue the LABA and increase dose of ICS to low dose …OR… Alternatively continue the LABA continue very low dos ICS and add leukotriene receptor antagonist (Montelukast)

Children Aged Under 5yrs

  • LABA isn’t licensed in this age group
  • Probably best to refer in to paeds – consider increasing dose of ICS to low-dose while awaiting review

Next Step

  • Consider Oral Steroids at lowest dose to provide adequate control

Inhaled Corticosteroids

Very low dose

  • Beclometasone Clenil 50mcg – two puffs BD
  • Fluticasone Flixotide 50mcg – one puff bd

Low dose

  • Beclometasone Clenil 100mcg – two puffs BD
  • Beclometasone Qvar 50mcg – two puffs BD
  • Fluticasone Flixotide 50mcg – two puffs BD

Medium

  • Beclometasone Clenil 200mcg – two puffs BD
  • Beclometasone Qvar 100mcg – two puffs BD
  • Fluticasone Flixotide 125mcg – two puffs BD