NEW GINA GUIDELINES FOR OUTPATIENT MANAGEMENT:
- “Preferred therapy for patients with symptoms less often than twice monthly is either (a) as-needed low-dose ICS/formoterol (formoterol is a long-acting β-agonist [LABA] with a quick onset of action) or (b) as-needed ICS whenever as-needed SABA is used. GINA strongly discourages use of as-needed monotherapy with a SABA (e.g., albuterol), even in patients with only mild symptoms — and that is a major departure from typical U.S. practice.”
- Inhaled corticosteroids (ICSs) continue as preferred long-term control therapy for all ages
- For systemic steroids, the “Number Needed to Treat” (NNT) of asthma exacerbations is 8 to avoid 1 hospitalization
- PRN ICS/LABA (eg Advair/Symbicort) as needed may be equivalent to a daily ICS
- Giving steroids to kids under age 5 may be a “Thing We Do For No Reason”
- Harms of Steroids: Short course Systemic Steroids lead to ~1.17x increased fracture in pediatric patients and is associated with increased risk of sepsis, VTE, and fractures in adults
- Med-Peds Fun Fact: For adult asthma (and COPD) exacerbation, 40mg of prednisone is typically the standard of care treatment. For pediatric asthma exacerbations, 2mg/kg of prednisolone is used up to 60mg. i.e. your obese 14 year old may get a higher dose of steroids than your 40 year old.
- Decadron vs. Prednisolone in the Pediatric ED
- Peds In Review (Nov 2019)
- Check out this “Clinic Wiki” page for other pearls on asthma
QUESTIONS TO PONDER!
- How do you diagnose asthma in children?
- Should we be using the Asthma Control Test (ACT) and / or Peak Flows to monitor asthma in our patients?
- When should we recommend leukotriene modifiers (e.g. montelukast)?
- What is the difference between Controlled asthma and Severity of asthma?
- What are the PROs and CONs of oral steroids for an asthma exacerbation?
- Decadron or Prednisone?
ED / Inpatient:
- Why do we do DuoNebs in the ED but not after admission?
- Why do we give fluids with Magnesium?
- What is the difference between CPAP and BiPap?
- What is the difference between an ABG and a VBG?
- How would you expect a blood gas to evolve during a worsening asthma exacerbation in the absence of treatment?
- How might an asthma exacerbation lead to cardiac arrest?