See BTS/SIGN/NICE 2025 guidance on asthma, asthma prevention, asthma and obesity
FeNO is expensive and available in only a minority of GP practices and hospital services. Requiring it means GPs can no longer make diagnosis themselves.
Spirometry results in most primary care patients with asthma are normal!
Spacer best for everyone! Orange aerochamber is small mask, up to 18 months, yellow is 1-5yrs. Green is 5+, blue is adult. You can get blue with mask, not green.
200 doses in an MDI. 2 puffs BD exhausts an MDI in 50 days. Multidosing 5 puffs 4hrly will exhaust it in 6 days.
Growth Restriction
Children who use inhaled steroids for asthma grow slower than their peers in the first year of taking the medication, by about half a centimetre per year. Metanalysis of 25 trials, various types of steroid. Seems to be most obvious in initial year of treatment. Only 1 study followed children into adulthood – budesonide, used for average of 4 years – reduction in final height of 1.2cm (Kelly, PMID 22938716).
Should therefore be prescribed at the lowest effective dose. Cochrane 2014 found significant difference between low dosing (50-100 Clenil equivalent) and medium dosing of 0.2cm per year but noted that the majority of trials did not report height data.
However, the small effect on growth needs to be weighed against the proven benefits of these drugs in controlling asthma, and ensuring children’s lungs grow to their full capacity. Undertreated asthma is much more likely to have a harmful effect on a child’s development than a small reduction in growth.
Newer Therapies
Xolair=Omalizumab, monoclonal vs IgE. Subcut, 2-4 weekly, for age 6+ where conventional therapy not working. Other criteria are total igE >30, positive tests for aeroallergens, FEV1<80%.
Airsonett is evidence based, temperature controlled laminar flow system for bedroom. Noisy!
Management
See National review of asthma deaths. Recommendations include:
- Refer specialist if >=2 courses oral steroids within 12 month period
- Follow up after every ED/OOH attendance
- Hospital follow up after every hospital attendance
- Annual inhaler technique check
- Personal asthma plan for everyone
See MyLungsMyLife.org website for self management.