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British Guideline on the MAnAGeMent of AsthMA 6.11 treAtMent of ACute AsthMA in Children AGed less thAn 2 yeArs 6.11.1 β 2 AGONIST BRONCHODILATORS 74 A trial of bronchodilator therapy should be considered when symptoms are of concern. If inhalers have been successfully administered but there is no response, review the diagnosis and consider the use of other treatment options. Inhaled β agonists are the initial treatment of choice for acute asthma. Close fitting face masks 2 are essential for optimal drug delivery. The dose received is increased if the child is breathing appropriately and not taking large gasps because of distress and screaming. There is good evidence that pMDI + spacer is as effective as, if not better than, nebulisers for treating mild to moderate asthma in children aged ≤2 years. 355,478,479 A for mild to moderate acute asthma, a pMdi + spacer is the optimal drug delivery device. Whilst β 2 agonists offer marginal benefits to children aged
New 2011 7 special situations 7.1 AsthMA in AdolesCents 7.1.1 DEFINITIONS Adolescence is the transitional period of growth and development between puberty and adulthood, defined by the World Health Organisation (WHO) as between 10 and 19 years of age. 864 There is international agreement on best practice for working with adolescents with health problems outlined in consensus publications. 865-867 Key elements of working effectively with adolescents in the transition to adulthood include: 868 seeing them on their own, separate from their parents or carers, for part of the consultation, and discussing confidentiality and its limitations. For diagnosing and managing asthma in adolescents, the evidence base is limited. Much recent research has focused on the prevalence of asthma and ecological risk associations rather than on diagnosis and management of asthma in adolescents. 7.1.2 PREvALENCE OF ASTHMA IN ADOLESCENCE Asthma is common in adolescence with a prevalence of wheeze in Western Europe in the past 12 months (current wheeze) in 13-14 year olds of 14.3%. 869 For more severe asthma (defined as ≥4 attacks of wheeze or ≥1 night per week sleep disturbance from wheeze or wheeze affecting speech in the past 12 months) the prevalence was 6.2%. There is evidence of under-diagnosis of asthma in adolescents, with estimates of 20-30% of all asthma present in this age group being undiagnosed. 869-872 This has been attributed to under-reporting of symptoms. A number of risk factors have independently been associated with under-diagnosis including: female gender, smoking (both current smoking and passive exposure), low socioeconomic status, family problems, low physical activity and high body mass and race/ethnicity. 872 Children with undiagnosed frequent wheezing do not receive adequate healthcare for their illness872 and the health consequences of not being diagnosed with asthma are substantial. 873,874 Although feasible, there is insufficient evidence to support screening for asthma in adolescents. 875,876 ; Clinicians seeing adolescents with any cardio-respiratory symptoms should consider asking about symptoms of asthma. 7 sPeCiAl situAtions 75
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101 British Guideline on the Manage
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British Thoracic Society Scottish I
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Revised 2011 Revised 2011 Revised 2
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1 introduction 1.1 the need for A G
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1.3.1 PATIENT vERSION Patient versi
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Table 1: Clinical features that inc
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Case detection studies have used sy
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2.1.6 CHILDREN WITH AN INTERMEDIATE
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2.3 suMMAry focus the initial asses
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2.4 diAGnosis in Adults The diagnos
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2.4.1 FURTHER INvESTIGATION OF PATI
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Table 6: Differential diagnosis of
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2.5.1 TREATMENT TRIALS AND REvERSIB
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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: 6.9.3 Iv MAGNESIUM SULPHATE Intrave
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
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Annex 11 (contd) Annexes 125
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56. Abu-Hasan M, Tannous B, Weinber
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156. Lodrup Carlsen KC, Carlsen KH,
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256. Malmstrom M, Ahlner J, Carlsso
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352. Brocklebank D, Ram F, Wright J
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456. McDowell KM, Chatburn RL, Myer
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562. McDonald JC, Keynes HL, Meredi
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668. Enright PL, McClelland RL, New
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767. Berger W. Budesonide inhalatio
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862. Pedroletti C, Lundahl J, Alvin
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ISBN 978 1 905813 28 5 British Thor
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