儿童哮喘管理老外讲者.ppt

UPDATE ON THE CLINICAL MANAGEMENT OF ASTHMA IN THE YOUNG CHILD Asthma Guidelines BTS-SIGN Guidelines: 2004 BTS-SIGN Guidelines: 5-12 year old BTS-SIGN Guidelines: 5 year old GINA Guidelines: 2005 GINA Guidelines: Adults and 5 year old GINA Guidelines: 5 year old Canadian Pediatric Asthma Guidelines: 2005 www.cma.ca Asthma in the young child Annual Incidence Rates for Asthma Melbourne Epidemiological Study of Childhood AsthmaLung Function Over Time Asthma in the young child Asthma in Childhood Wheeze after RSV Bronchiolitis Diagnosis of Asthma A Clinical Index to Define Asthma Risk* Asthma in the Young Child BTS-SIGN Guidelines: 2004 BTS-SIGN Guidelines: 5 year old GINA 2005 Guidelines: 5 year old GINA 2006 : Children older than 6 years GINA 2006: Children 5 years and Younger GINA 2006 : Children 5 years and younger Intermittent Asthma in Early Childhood Male, 2 years old RSV bronchiolitis at 3 months Cough and Wheezing with “colds” 5-6 times since Atopic dermatitis Slightly better with salbutamol How would you manage ? Inhaled Corticosteroids for Children Intermittent ICS for URI Inhaled Corticosteroids for Children Intermittent ICS for URI Inhaled Corticosteroids for Children Intermittent ICS for URI Recurrent Wheeze in the Young Child Intermittent Oral Steroids Intermittent Oral Steroids Intermittent Oral Steroids Recurrent Wheeze in the Young Child Short course montelukast for intermittent asthma in children : Pre-Empt Short course montelukast for intermittent asthma in children Pre-Empt – Health Resource Use Pre-empt :Time Off School Pre-empt :Time Off School/Work Canadian Pediatric Asthma Consensus A Clinical Index to Define Asthma Risk* First-line maintenance therapy Recommend ICS as the best option for anti-inflammatory monotherapy for childhood asthma There is insufficient evidence to recommend LTRAs as first-line mono-therapy for childhood asthma. For children who cannot or will not use ICS, LTRAs represent an alter