1. Paediatric Asthma Maria Tracey Paediatric Pharmacist Jane Davis Paediatric Clinical Nurse Specialist CF/Respiratory Royal Alexandra Hospital Paisley

2. Objectives Explain the stepwise approach to the treatment of chronic asthma in children Demonstrate the choice of inhaler devices used in children Demonstrate multidosing

4. Statistics 5.2 million people in UK 1.1 million children

5. What is Asthma? Or a combination of all three Swelling Inflammation Excess mucus Asthma is a condition of the airways where there is difficulty in breathing due to

6. Asthma Triggers Infections (eg colds and viruses) House-dust mite Pets (furred / feathered) Second hand smoke Exercise Pollens/moulds

7. The Impact of Asthma Night cough, disturbed nights Restriction in activity / exercise Increased school absences Ongoing symptoms may have a detrimental effect on physical, psychological and social well-being

8. Children age 5-12 yrs

14. Combination Inhalers Steroid/LABA Can improve compliance Useful when asthma stable Lack of flexibility to  or  dose

15. Key Points Dose equivalence of corticosteroids CFC free corticosteroid inhalers Accurate medication history

16. Relievers Preventers Additional Treatments Asthma Medications

17. Easyhaler

18. Overview: Inhaler devices Inhaler devices. Thorax 2003; 58 (Suppl I): i1-i92 pMDI + spacer is preferred delivery method in children aged 0-5 years pMDI + spacer is as effective as other delivery methods for other age groups Choice of inhaler should be based on patient preference and ability to use

19. Multidosing Multiple puffs(up to 10) of a short-acting ß2 agonist via a spacer device is as effective as nebulised Children(and adults) with mild and moderate exacerbation of asthma should be treated by bronchodilator given from a pMDI + spacer with doses titrated according to clinical response

21. Summary: Paediatric asthma Inhaled steroids are the recommended preventer drug In children >5 years, add inhaled long acting ß 2 agonists rather than increasing the dose of inhaled steroids above 400mcg/day pMDI + spacer is preferred delivery method in children aged 0-5 years, and as effective as other delivery methods for other age groups

22. References www.Asthma.Org.Uk Tel 02077865000www.Asthma.Org.Uk British Thoracic Society, Scottish Intercollegiate guidelines Network (2008) British Guideline on the Management of Asthma Thorax (63) Supplement 1V