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GINA Guidelines : particularités pédiatriques

GINA Guidelines : particularités pédiatriques. Dr G de Bilderling Pneumologie pédiatrique CHR Namur. Prevalence increasing in many countries, especially in children Factors that Exacerbate Asthma : Viral infections +++ Asthma Diagnosis Spirometry > 6y Measurements of allergic status.

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GINA Guidelines : particularités pédiatriques

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  1. GINA Guidelines : particularités pédiatriques Dr G de Bilderling Pneumologie pédiatrique CHR Namur

  2. Prevalence increasing in many countries, especially in children • Factors that Exacerbate Asthma : • Viral infections +++ • Asthma Diagnosis • Spirometry > 6y • Measurements of allergic status

  3. Asthmatic phenotypes - 75 Martinez J Allergy Clin Immunol 2003;111:661 Pronostic 1

  4. Modified Asthma Predictive Index < 3 years and recurrent wheezing episodes and 1 criteria : • Parental asthma • • Atopic dermatitis • • Aeroallergern sensitization or : 2 criteria • allergic rhinitis • Wheezing episodes not associated with URTI • Eosinophilia 75% of these children will have active asthma Pronostic 7 Castro - Rodriguez AJRCCM 2000;162: 1403 - 1406

  5. SUMMARY OF STEPWISE MANAGEMENT IN CHILDREN LESS THAN 5 YEARS British guidelines on the management of asthma. Thorax 2003, 58

  6. Estimate Comparative Daily Dosages for Inhaled Glucocorticosteroids by Age Drug Low Daily Dose (g) Medium Daily Dose (g) High Daily Dose (g) > 5 y Age < 5 y > 5 y Age < 5 y > 5 y Age < 5 y

  7. Survey of adrenal crisis associated with inhaled corticosteroids in the United KingdomTodd GRG, Acerini CL, Ross-Russel R, Zahra S, Warber JT, McCance D.Arch Dis Child 2002; 87: 457-461. Children Adults • Males/females (n) 17/11 3/2 • Mean age (yrs) : 6.4 (3.3-10) 41 (18-80) • Presentation (n) : • Acute hypoglycaemia 23 1 • Decreased consiousness/coma 13 0 • Coma and convulsions 10 1 ( Death : pneumococcal septicaemia) 1 • Insidious 5 4 • Duration of ICS R/ (yrs) 1.7 (n = 22) 3.3 (n = 4) • Mean dose of FP 980 1380 in µg/day (range) (500-2000) (1000-2000

  8. Age-related devices

  9. fréquence d’usage correct des inhalateurs (%) adultes enfants 72 64 58 62 78 68 67 82 60 55 22 20 1 - secouer préalablement avant l’usage 2 - débuter l ’inspiration avant d’activer l’inhalateur 3 - inhaler doucement et profondément 4 - activer l’inhalateur en une seule fois 5 - retenir sa respiration 5 sec ou + après inhalation technique optimale Aérosols doseurs : UTILISATION INCORRECTE Deux asthmatiques sur trois utilisent mal les aérosols* * résultats d’une enquête INSERM sur 768 patients adultes et enfants

  10. Asthma Management and Prevention Program:Summary • Young children are more difficult to diagnose. • Treatment (inhalation device) must be adapted to age. • Partnership is even more important in this age-group.

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