Wheezing in Childhood- Management of Childhood Asthma

Barnet CEPN June 2017 MCLG session Wheezing in Childhood- Management of Childhood Asthma

Professionals who will find this of relevance: Primary care and Paediatric clinicians, Practice Nurses, Paediatric Nurse specialists, Community & Practice Pharmacists, Community Nurses, Health Visitors, School Nurses, Paediatric teams.

Aims and Objectives of the session

To increase awareness of recommendations of NRAD To increase awareness of resources available- Healthy London Partnership Asthma toolkit To share and improve understanding and management of paediatric asthma.

Areas of focus: Preschool wheeze Established childhood asthma

Part 1 -1.00– 1.30 (1.30 – 2.00)

Facilitators introduction – Video (optional) https://www.myhealth.london.nhs.uk/healthy-london/programmes/children-and- young-people/london-asthma-toolkit/parents-and-carers/film

RFH/ Barnet Paediatric teams Healthy London Partnership ( HLP)Asthma teams.

Introduce – NRAD study , HLP, Recent coroners report- lessons learnt. https://www.judiciary.gov.uk/wp-content/uploads/2017/03/Uriely-2017-0069_Redacted.pdf

Part 2 1.30 – 2.10 ( 2.00 – 2.40)

Cases (3 cases- Jonny, Gemma and Chris) & Coroners report - small groups Discuss cases and Coroners report

Plenary 2.10 – 2.25 ( 2.40 – 2.55)

Feedback & Action plan:

Any learning points? What 3 changes might you consider to your own clinical practice? What 3 changes might you take back to your clinical setting?

Evaluation 2.25 – 2.30 ( 2.55 – 3.00) Wheeze cases for Asthma HLP teaching

Rahul Chodhari (Consultant) RFH [email protected] John King (ST5) BGH [email protected] Joanna Yong GP Barnet CCG [email protected] Barnet CEPN June 2017 MCLG session Wheezing in Childhood- Management of Childhood Asthma

Case 1:

4 year old Jonny comes to the GP’s surgery with difficulty in breathing. His parents have reported a runny nose and reduced oral intake in the last few days.

There have been multiple similar episodes with an URTI. Some have required admission to the local Paediatric Ward, requiring inhalers/nebulisers overnight. He has not required any IV therapy or HDU/PICU input.

On examination, wide spread wheezes were heard with an increased effort of breathing. On this occasion, Salbutamol inhaler via a spacer has helped (similar to previous occasions).

His parents are very concerned he has asthma and want a referral to the Brompton for further investigations.

1) What further information would you want to know?

Further information:

The family has two dogs & Jonny has always been fine with them. There is no family history of asthma, atopy or smoking. His parents have reported that Jonny is fine playing in park & cold weather is not something that makes his symptoms worse. He has been very well between his last two episodes & he has not required any regular medications such as Salbutamol inhaler. There is no history of food allergy or allergic rhinitis symptoms in him.

The child has improved & inhalers were not required after he recovered from the cold.

2) Is this Preschool wheeze or Asthma? Why?

Discuss the next steps in your professional setting.

Consider your follow up options for this child.

3) Would you start a preventer therapy?

4) What are the medication options?

5) Which professionals might you involve in this child’s care?

Case 2:

3 year old Gemma comes to the GP’s surgery with difficulty in breathing. Her parents have reported a runny nose and reduced oral intake in the last few days.

There have been three previous similar episodes, one of which was an URTI & another with a cold. She has been admitted once to the local paediatric unit. The family has no animals at home; however, her parents smoke, “but never in front of Gemma.” She has frequent night time coughing in the winter months. There is no family history of asthma or atopy. The parents have reported that Gemma does wheeze whilst playing in the park and also when they had some building work done and it was dusty. This has improved with her inhaler. She is generally well but her parents feel that the cold reaches her chest rather faster than her siblings. There is no history of allergic rhinitis symptoms, but she has a food allergy to mixed nuts.

On examination, wide spread wheezes were heard with an increased effort of breathing. On this occasion, Salbutamol inhaler via a spacer has helped (similar to previous occasions). The child has improved & her parents had stopped the inhalers once she had recovered.

Her parents are very concerned she has asthma and want a referral to the Brompton for further investigations.

6) Would you like any further information?

7) Is it Preschool wheeze or asthma? Why?

Discuss the next steps in your professional setting.

8) Would you start a preventer therapy? What are the options?

Consider your follow up options for this child.

9) How would you address the parental concerns?

Case 3:

11 year Chris attends with his mum. He has been ‘asthmatic’ since early childhood. His family has just moved to the area and he has come to see you for a review of medication. He is currently taking salbutamol MDI PRN and Beclometasone 200mcg BD. He says he has good control currently.

10) What is important in reviewing his control? Which asthma control tools are available to help?

Chris tells you he uses his salbutamol most days, after playing football at lunch, or when he has to go to the top floor of the tower block at school, 3 stories up. He had a spacer but it got lost in the move so he just puts the device in his mouth. He coughs at night but that doesn’t bother him. His dad smokes ‘but only outside’ and they have a golden retriever at home. He says he takes his brown inhaler most days. He’s never tried any other preventer inhalers.

11) How do you rate his control?

12) What would you like to do with his medication?

Coroner’s report Discuss findings What 3 changes might you consider to your own clinical practice? What 3 changes might you take back to your clinical setting?

Rahul Chodhari (Consultant) RFH [email protected] John King (ST5) BGH [email protected] Joanna Yong GP Barnet CCG [email protected]