Disclosure. Update in Pediatric Asthma 7/5/16. Topics. California Society for Respiratory Care Indian Wells, CA June 7, 2016

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1 Update i Pediatric Asthma Califoria Society for Respiratory Care Idia Wells, CA Jue 7, 2016 Sade Okelo, MD, PhD The David Geffe School of Medicie at UCLA Mattel Childre s Hospital Divisio of Pediatric Pulmoology sokelo@medet.ucla.edu 1 Disclosure I have o relevat fiacial relatioships with commercial iterests. Topics 1. Asthma statistics i childre 2. Uderstad the role of iflammatio ad brochospasm i asthma eacerbatios 3. Review the classes of asthma medicatios ad their roles i treatig acute ad chroic asthma 4. Cosideratios i use of MDIs to deliver short-actig beta2 agoists (SABA) 3 1

2 Asthma Statistics i Childre Asthma Pathogeesis: Iflammatio & Obstructio 7 millio U.S. childre (~10%) 52% with a asthma attack i last 12 moths 7,500,000 ambulatory visits for asthma per year (60% of kids) 640, 000 ED visits for asthma per year (7.5% of kids with asthma) 157,000 hospitalizatios per year (1.4% of childre with asthma) 186 deaths per year LJ Akibami Vital & Health Statistics Dec 12, 2006;381 LJ Akibami Nat l Health Statistics Report 2011:vol 32 Scietific America Medicie Early ad Late Phase Topics 1. Asthma statistics i childre 2. Uderstad the role of iflammatio ad brochospasm i asthma eacerbatios 3. Review the classes of asthma medicatios ad their roles i treatig acute ad chroic asthma 4. Cosideratios i use of MDIs to deliver short-actig beta2 agoists (SABA) 2

3 2 6 puffs 1 dose every 20 mi 1 hr For URIs, per dose cough, wheeze, SOB 4 times a day 1 ihaler = 12 moths Nebulized Brochodilators 2.5mg if <30kg 5mg if >30kg Aticholiergic+β2 agoists better tha β2 agoists aloe: reducig hospital admits Albuterol Ihalatio for Status Asthmaticus ( 12 yrs) 11 Beedict Griffiths, Cochr Syst Rev, Published Olie: 21 AUG

4 Ati-choliergic + β2 agoist: multiple doses most effective i mod severe eacerbatios: admits Aticholiergic+β2 agoists better tha β2 agoists aloe Lug fuctio Hypoia Tremor Rodrigo G J, ad Castro-Rodriguez J A Thora 2005;60: Beedict Griffiths, Cochr Syst Rev, Published Olie: 21 AUG MDI+VHC versus Nebs for Short-actig B2 agoists Dose with MDI+VHC = 300µg (most 500µg) 1,000 µg Neb doses of SABA: 2.5 5mg Equivalet/better efficacy favorig MDI+VHC cliical score; O2 saturatios; lug fuctio; hospital admit Equal/fewer side-effects (tachycardia) Tight fittig facemask ad quiet breathig icrease delivery of aerosol to lugs Loose fittig facemask durig MDI/spacer delivery Tight fittig facemask ad child screamig durig ebulizer delivery Lower admissio rate Potetially a efficiet, easier method of deliverig albuterol Attractive alterative treatmet modality i the ED. Tight fittig facemask ad child breathig quietly durig MDI/ spacer delivery Tight fittig face mask ad child breathig quietly durig ebulizer delivery JA Castro-Rodriguez J Ped 2004;145:172 L Hedeles Am J health-syst Pharm May 15, 2005 (62):1053 Erziger S, et al. J. Aerosol Medicie 2007; 20 (suppl 1):S78-S84. 4

5 Icrease dose delivered to lugs by oral delivery of aerosols ose-breathig ifats mouth breathig childre ad adults ose breathig childre ad adults Bailey MDI Use Abilities: State to Caregiver/Patiet: Please show me how you use the ihaler Desirable Behavior Yes (1 poit) No (0 poits) Caregiver/Patiet shakes caister for 5 secods Caregiver/Patiet attaches spacer correctly Caregiver/Patiet positios figer o the top of the medicatio caister ad provides support Patiet ehales ormally Caregiver/Patiet places the spacer tube or mouthpiece ito the mouth betwee the teeth Patiet closes lips aroud the spacer tube/mouthpiece Caregiver/Patiet correctly presses dow the top of the medicatio caister to release the medicatio Patiet ihales medicatio deeply ad slowly Patiet holds the medicatio iside the lugs a miimum of 3 secods before ehalig Oral Corticosteroids 19 5

6 Oral Steroids for Moderate/Severe Persistet Asthma 1mg/kg/day 3 10 days with Albuterol Predisoloe (15mg/5ml) Predisoloe (15mg/5ml) OraPred (15mg/5ml) Topics 1. Asthma statistics i childre 2. Uderstad the role of iflammatio ad brochospasm i asthma eacerbatios PediaPred (5mg/5ml) Preloe Syrup (5mg or 15mg/5ml) 4 times a day Predisoe Tabs (1, 2.5, 5, 10, 20, 50mg) 3. Review the classes of asthma medicatios ad their roles i treatig acute ad chroic asthma 4. Cosideratios i use of MDIs to deliver short-actig beta2 agoists (SABA) Used every day Treat Iflammatio so used daily 2 puffs for 3 moths - years 2 times a day Decrease or stop whe asthma well-cotrolled for 3 moths Oce Daily Optios 6

7 Summary Recap 1. Lower airway iflammatio ad brochospasm are the basis of asthma eacerbatios Comprehesive Assessmet Recommeded 2. Acute asthma therapy is based o use of systemic steroids ad short-actig beta2 agoists 3. Chroic asthma therapy is based o the daily use of ihaled steroids. 4. Use of MDIs for SABAs is as/more effective tha ebulizers 5. Stadardized ihaler assessmets ad educatioal materials are available Score SpO2 >95% o RA 91 95% Requires O2 Ispiratory Breath Souds Accessory Muscle Use Epiratory Wheezig Normal Selectively dimiished Globally decreased/ abset Normal Preset 3 of: subcostal, itercostal, substeral, suprasteral, supraclavicular, asal flarig Noe Preset Marked: may iclude ispiratory & epiratory Metal Status Normal Depressed/ Agitated Very lethargic; almost o movemet; very slow to respod Breathlessess Noe Mild moderate Severe SOB Vocalizatio Orthopea Respiratory Rate Speech/ Cry Normal Tolerates beig supie <1 yr: < yr: < yr: <30 >14 yr: <25 Partial seteces, short cry or poor po Resists beig supie Abset: short phrases, grutig or uable to po <1 yr: > yr: > yr: >30 JACI Jul;132(1): >14 yr: >25 JACI Pract Mar-Apr;2(2):186 7

8 Commets/Questios? JACI Jul;132(1): JACI Pract Mar-Apr;2(2):