sign101

Recommendations

Info

British Guideline on the MAnAGeMent of AsthMA 6 Coexistence of atopic disease A history of other atopic conditions such as eczema and rhinitis increases the probability of asthma. Positive tests for atopy in a wheezing child also increase the likelihood of asthma. A raised specific IgE to wheat, egg white, or inhalant allergens such as house dust mite and cat dander, predicts later childhood asthma. 40,41 Other markers of allergic disease at presentation, such as positive skin prick tests and a raised blood eosinophil count, are related to the severity of current asthma and persistence through childhood. family history of atopy A family history of atopy is the most clearly defined risk factor for atopy and asthma in children. The strongest association is with maternal atopy, which is an important risk factor for the childhood onset of asthma and for recurrent wheezing that persists throughout childhood. 6,34,37,42,43 Abnormal lung function Persistent reductions in baseline airway function and increased airway responsiveness during childhood are associated with having asthma in adult life. 23 Table 3: Clinical clues to alternative diagnoses in wheezy children (features not commonly found in children with asthma) Perinatal and family history Possible diagnosis Symptoms present from birth or perinatal lung problem Cystic fibrosis; chronic lung disease of prematurity; ciliary dyskinesia; developmental anomaly Family history of unusual chest disease Cystic fibrosis; neuromuscular disorder Severe upper respiratory tract disease Defect of host defence; ciliary dyskinesia symptoms and signs Persistent moist cough18 Cystic fibrosis; bronchiectasis; protracted bronchitis; recurrent aspiration; host defence disorder; ciliary dyskinesia Excessive vomiting Gastro-oesophageal reflux (± aspiration) Dysphagia Swallowing problems (± aspiration) Breathlessness with light-headedness and peripheral tingling Hyperventilation/panic attacks Inspiratory stridor Tracheal or laryngeal disorder Abnormal voice or cry Laryngeal problem Focal signs in chest Developmental anomaly; post-infective syndrome; bronchiectasis; tuberculosis Finger clubbing Cystic fibrosis; bronchiectasis Cystic fibrosis; host defence disorder; Failure to thrive gastro-oesophageal reflux investigations Focal or persistent radiological changes Developmental anomaly; cystic fibrosis; post-infective disorder; recurrent aspiration; inhaled foreign body; bronchiectasis; tuberculosis 2 ++ 2 ++ 3
Case detection studies have used symptom questionnaires to screen for asthma in school-age children. A small number of questions - about current symptoms, their relation to exercise and their occurrence at night has been sufficient to detect asthma relatively efficiently. 11,12,14,44 The addition of spirometry 11,44 or bronchial hyper-responsiveness testing 45 to these questionnaires adds little to making a diagnosis of asthma in children. B focus the initial assessment in children suspected of having asthma on: presence of key features in the history and examination careful consideration of alternative diagnoses. ; Record the basis on which a diagnosis of asthma is suspected. 2.1.2 ASSESSING THE PROBABLITy OF A DIAGNOSIS OF ASTHMA Based on the initial clinical assessment it should be possible to determine the probability of a diagnosis of asthma. With a thorough history and examination, an individual child can usually be classed into one of three groups (see Figure 1): high probability – diagnosis of asthma likely low probability – diagnosis other than asthma likely intermediate probability – diagnosis uncertain. 2.1.3 HIGH PROBABILITy OF ASTHMA In children with a high probability of asthma based on the initial assessment, move straight to a diagnostic trial of treatment. The initial choice of treatment will be based on an assessment of the degree of asthma severity (see section 4). The clinical response to treatment should be reassessed within 2-3 months. In this group, reserve more detailed investigations for those whose response to treatment is poor or those with severe disease. 19 ; In children with a high probability of asthma: start a trial of treatment review and assess response reserve further testing for those with a poor response. 2.1.4 LOW PROBABILITy OF ASTHMA Where symptoms, signs or initial investigations suggest that a diagnosis of asthma is unlikely, (see Table 2), or they point to an alternative diagnosis (see Table 3), consider further investigations. This may require referral for specialist assessment (see Table 4). Reconsider a diagnosis of asthma in those who do not respond to specific treatments. ; In children with a low probability of asthma, consider more detailed investigation and specialist referral. 2 diAGnosis 2 + 7
Page 1 and 2: 101 British Guideline on the Manage
Page 3 and 4: British Thoracic Society Scottish I
Page 5 and 6: Revised 2011 Revised 2011 Revised 2
Page 7 and 8: 1 introduction 1.1 the need for A G
Page 9 and 10: 1.3.1 PATIENT vERSION Patient versi
Page 11: Table 1: Clinical features that inc
Page 15 and 16: 2.1.6 CHILDREN WITH AN INTERMEDIATE
Page 17 and 18: 2.3 suMMAry focus the initial asses
Page 19 and 20: 2.4 diAGnosis in Adults The diagnos
Page 21 and 22: 2.4.1 FURTHER INvESTIGATION OF PATI
Page 23 and 24: Table 6: Differential diagnosis of
Page 25 and 26: 2.5.1 TREATMENT TRIALS AND REvERSIB
Page 27 and 28: A small prospective observational s
Page 29 and 30: Table 8: Summary of tools that can
Page 31 and 32: Measurement Methodology Asthma Cont
Page 33 and 34: Measurement Methodology Eosinophil
Page 35 and 36: 3.1.2 FOOD ALLERGEN AvOIDANCE Sensi
Page 37 and 38: The limited data on antenatal or ea
Page 39 and 40: 3.3.2 AIR POLLUTION Challenge studi
Page 41 and 42: 3.5 CoMPleMentAry And AlternAtive M
Page 43 and 44: Revised 2011 4 Pharmacological mana
Page 45 and 46: Table 8b: Equivalent doses of inhal
Page 47 and 48: 4.2.3 SAFETy OF INHALED STEROIDS Th
Page 49 and 50: 4.3.2 ADD-ON THERAPy Options for ad
Page 51 and 52: 4.4 steP 4: Poor Control on ModerAt
Page 53 and 54: 4 PhArMAColoGiCAl MAnAGeMent Colchi
Page 55 and 56: MOVE UP TO IMPROVE CONTROL AS NEEDE
Page 57 and 58: 4.6 stePPinG doWn Stepping down the
Page 59 and 60: 4.7.5 ASPIRIN-INTOLERANT ASTHMA The
Page 61 and 62: 5.3 inhAled steroids for stABle Ast
Page 63 and 64:
Revised 2009 6 Management of acute
Page 65 and 66:
Patients with brittle or difficult
Page 67 and 68:
Table 11: Initial assessment - the
Page 69 and 70:
In acute asthma without life threat
Page 71 and 72:
6.3.8 ANTIBIOTICS 6.3.9 HELIOx When
Page 73 and 74:
6.6.2 PATIENT EDUCATION Following d
Page 75 and 76:
6.7.2 PULSE OxIMETRy 6.7.3 PEF Accu
Page 77 and 78:
Frequent doses up to every 20-30 mi
Page 79 and 80:
6.9.3 Iv MAGNESIUM SULPHATE Intrave
Page 81 and 82:
New 2011 7 special situations 7.1 A
Page 83 and 84:
Gender During adolescence there is
Page 85 and 86:
Complementary and alternative medic
Page 87 and 88:
Table 13: Recommendations for organ
Page 89 and 90:
7.2 diffiCult AsthMA 7.2.1 DEFINING
Page 91 and 92:
Revised 2009 Controlled studies usi
Page 93 and 94:
Continuous fetal monitoring should
Page 95 and 96:
C use steroid tablets as normal whe
Page 97 and 98:
7.9.2 AT-RISK POPULATIONS Several h
Page 99 and 100:
7.9.6 SPECIFIC BRONCHIAL PROvOCATIO
Page 101 and 102:
Asthma clinics in primary care may
Page 103 and 104:
A 8.3 Audit discharge from hospital
Page 105 and 106:
9 Patient education and self manage
Page 107 and 108:
9.2.1 COMPLIANCE WITH MONITORING AN
Page 109 and 110:
Table 15. Summary of the key compon
Page 111 and 112:
8. What role does patient preferenc
Page 113 and 114:
Dr James Paton* Reader and Honorary
Page 115 and 116:
INHALER DEvICES Dr John White (Chai
Page 117 and 118:
11.4 disseMinAtion GrouP Mrs Sheila
Page 119 and 120:
Abbreviations ABG arterial blood ga
Page 121 and 122:
Annex 2 Management of acute severe
Page 123 and 124:
Annex 4 Features of acute severe as
Page 125 and 126:
Annex 6 Consider prednisolone 20 mg
Page 127 and 128:
Annex 8 Management of acute asthma
Page 129 and 130:
Annex 10 PEF (l/min) EU Scale 680 6
Page 131 and 132:
Annex 11 (contd) Annexes 125
Page 133 and 134:
56. Abu-Hasan M, Tannous B, Weinber
Page 135 and 136:
156. Lodrup Carlsen KC, Carlsen KH,
Page 137 and 138:
256. Malmstrom M, Ahlner J, Carlsso
Page 139 and 140:
352. Brocklebank D, Ram F, Wright J
Page 141 and 142:
456. McDowell KM, Chatburn RL, Myer
Page 143 and 144:
562. McDonald JC, Keynes HL, Meredi
Page 145 and 146:
668. Enright PL, McClelland RL, New
Page 147 and 148:
767. Berger W. Budesonide inhalatio
Page 149 and 150:
862. Pedroletti C, Lundahl J, Alvin
Page 151:
ISBN 978 1 905813 28 5 British Thor
show all

sign101

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?