Asthma in children

Dr Diana North, Goodfellow Unit GP Advisor talks with Dr David McNamara, Paediatric Respiratory and Sleep Medicine Specialist employed at Starship Childrens Hospital in Auckland, NZ. 

Dr McNamara discusses what is new in the diagnosis and management of asthma in children up to 16 years of age. The goals of treatment and using a stepped approach to treatment in children is overviewed, as well as:

  • What issues to discuss with parents and children to educate them about asthma.
  • What is changing with lifestyle advice – dust mites and pets.
  • The role for allergy testing.
  • Using a stepped approach to asthma treatment in children
  • New pharmaceuticals available in New Zealand to manage asthma in children
  • What delivery systems to use with children
  • The use of personalised action plans

  

 

Resources

Asthma Management Plans

     

Peer group discussion points

1. There is now more of an emphasis on the clinical pattern of symptoms, usual triggers and response to treatment rather than using serial peak expiratory flow rate (PEFR) recordings.
  • How do you routinely assess a child’s asthma control? 
  • In what situations would you use a PEFR recording in children (if at all)?
  • Do you have any strategies to ensure children with asthma have regular monitoring of symptom control (particular consider stepping up treatment in poor control or stepping down treatment where there is very good control)?
  • Do you think these strategies are effective in your population? Discuss ways you might be able to improve the monitoring of children with asthma, particularly to ensure tight control before typical winter viral seasons.

 
2. Education and provision of an Asthma Action Plan is an important part of managing asthma in children.

  • What education and lifestyle advice do you given to children and their parents/caregivers?
  • Who gives this information and how do you manage covering so much information?
  • Do you have any favourite resources that you use for patient education?
  • Do you feel confident providing an asthma action plan?
  • Are there any aspects of this that you find challenging, if so, what are these and how do the others manage?

3. Children are quite vulnerable to inhaled corticosteroids, so it is important to be aware of the maximum daily doses in childhood and to monitor growth.

  • What are some ways that growth can be monitored in children with asthma who are taking inhaled corticosteroids? Is there any consensus how frequently growth needs to be checked? What would you do if growth was faltering?

4. Annual influenza vaccination is recommended for children with asthma.

  • Has anyone undertaken an audit of influenza vaccination in children with asthma? What did it show? Did you make any changes to your systems or practice based on these findings?
  • What could you do differently (if anything) in your practice to improve the uptake of influenza vaccination in your patients with asthma?

This MedTalk is supported by

Date Published: 
Thursday, April 20, 2017