GINA5岁以下儿童哮喘规范化治疗课件.ppt

* * Initial management of asthma exacerbations in children ≤5 years Therapy Dose and administration Supplemental oxygen 24% delivered by face mask (usually 1L/min) to maintain oxygen saturation 94-98% Inhaled SABA 2–6 puffs of salbutamol by spacer, or 2.5mg by nebulizer, every 20 min for first hour, then reassess severity. If symptoms persist or recur, give an additional 2-3 puffs per hour. Admit to hospital if 10 puffs required in 3-4 hours. Systemic corticosteroids Give initial dose of oral prednisolone (1-2mg/kg up to maximum of 20mg for children 2 years; 30 mg for 2-5 years) GINA 2014, Box 6-10 Therapy Dose and administration Supplemental oxygen 24% delivered by face mask (usually 1L/min) to maintain oxygen saturation 94-98% Inhaled SABA 2–6 puffs of salbutamol by spacer, or 2.5mg by nebulizer, every 20 min for first hour, then reassess severity. If symptoms persist or recur, give an additional 2-3 puffs per hour. Admit to hospital if 10 puffs required in 3-4 hours. Systemic corticosteroids Give initial dose of oral prednisolone (1-2mg/kg up to maximum of 20mg for children 2 years; 30 mg for 2-5 years) Additional options in the first hour of treatment Ipratropium bromide For moderate/severe exacerbations, give 2 puffs of ipratropium bromide 80mcg (or 250mcg by nebulizer) every 20 minutes for one hour only Magnesium sulfate Consider nebulized isotonic MgSO4 (150mg) 3 doses in first hour for children ≥2 years with severe exacerbation 更新点 因为学龄前儿童频发呼吸道感染，由于对长期全身副作用的潜在风险的大量关注，在哮喘急性发作或者喘息的发作时，现在普遍不鼓励使用短程使用口服或者高剂量的ICS，特别当这些治疗频繁使用时。 What is new GINA2015 对于LTRA的推荐：由“急性期治疗的补充”提前到“在家初始治疗” 白三烯受体拮抗剂 2-5岁间歇性病毒喘息儿童，一项研究发现短程口服 LTRA（7-20天，起始于上出现呼吸道感染或者哮喘的第一个征兆）减轻症状，减少医疗资源使用，以及家长误工时间。对比另外一项研究发现没有减少无发作天数（主要研究终点）、口服激素使用、健康资源使用、生命质量和住院率；但是活动受限以及症状评分显著改善，特别是API阳性的患儿。 * * 谢 谢！ 仅供医学药学专业人士阅读 ? Global Initiative for Asthma GINA Global Strategy for Asthma Management and Prevention 2014 This slide set is restricted for academic and educational purposes only. Use of the slide set, o