Asthma: clinic management (2)
In this age group, a spacer device
with an appropriate face mask is used, e.g. a small volume Aerochamber®
or Ablespacer® which can take any inhaler; or a large volume Volumatic®
or Nebuhaler®, which only fit cer-tain inhalers. Prophylactic
therapy with inhaled steroids is more effective than cromoglicate.
·
Salbutamol
via Volumatic®: <2400micrograms/day (in 6 doses).
·
Terbutaline
via Nebuhaler®: <6000micrograms/day (in 6 doses).
·
Ipratropium
via Volumatic®: <480micrograms/day (in 4 doses).
·
Budesonide
via Nebuhaler®: 100–400micrograms/day.
·
Beclometasone
via Volumatic®: 100–400micrograms/day.
·
Salbutamol
via Volumatic®: <3600micrograms/day (in 6 doses).
·
Terbutaline
via Nebuhaler®: <6000micrograms/day (in 6 doses).
·
Budesonide
via Nebuhaler®: 100–800micrograms/day.
·
Beclomethasone
via Volumatic®: 100–800micrograms/day.
·
Fluticasone
via Volumatic®: (>4yrs) 100–200micrograms/day..
·
Salmeterol
via Volumatic®: (>4yrs) 50micrograms/day. Must never be given
alone and only when the child is also taking an inhaled steroid.
·
Combination inhaler: Seretide® (contains fixed doses of fluticasone
and salmeterol).
·
Salbutamol
Accuhaler®: <7200micrograms/day (in 6 doses).
·
Salbutamol
inhaler: (>12 years) <7200micrograms/day (in 6 doses).
·
Terbutaline
inhaler: (>12 years) <7200micrograms/day (in 6 doses).
·
Budesonide
Turbohaler®: 100–800micrograms/day.
·
Beclometasone
via Accuhaler®: 100–800micrograms/day.
·
Fluticasone
via Volumatic®: 100–400micrograms/day.
·
Combination
inhaler – Seretide® (contains fixed doses of fluticasone and
salmeterol); or Symbicort turbohaler® (fixed doses of budesonide and
formoterol).
·Fluticasone and budesonide are
preferable since they have fewer side-effects than beclometasone
·Patients on doses of steroids
greater than fluticasone 500micrograms/day, budesonide 800micrograms/day,
beclometasone 800micrograms/day should be under the supervision of a specialist
clinic
·Salmeterol may be of value for
night-time symptoms or daytime activity
·Should be used as a prophylactic
agent
·Consider in patients on inhaled
beclometasone or budesonide 400micrograms/day, or fluticasone 200micrograms/day
·Removal of feather or woollen
bedding
·Wrapping of mattress in plastic
·Cleaning of carpets and furniture
·No pets in the house if the child
is allergic to them
·No smoking in the house or car.
·Parents/carers must be strongly
encouraged to stop smoking completely.
Older patients will need to learn
more about their condition and how it is best treated. For example:
·Which medication to use and when
·Best inhaler technique
·What to do if asthma is getting
worse
·Not to smoke
·Gargle after steroid inhaler use
so as to avoid oral thrush
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