That have failed to achieve adequate control with optimised asthma therapy, despite formal assessment of and adherence to correct inhaler technique, which has been documented AND.Under the care of a respiratory physician, paediatric respiratory physician, clinical immunologist, allergist, paediatrician or general physician experienced in the management of patients with severe asthma. In Australia, tiotropium by mist inhaler is PBS-listed as an add-on treatment to ICS and LABA for severe asthma in patients: Evidence in a paediatric population demonstrated that tiotropium treatment for moderately severe asthma improved lung function (FEV 1), with non-significant trends towards improved asthma control and health-related quality of life ( Hamelmann et al. Promotes bronchodilation and increases airflow. A practical guide is also available in Table 8 of the following article by ( Liu et al. For further details on how to perform HPA axis tests consult with a local endocrinologist.Patient has persistent symptoms of adrenal suppression: Weakness/fatigue, malaise, nausea, vomiting, diarrhoea, abdominal pain, headache (usually in the morning), poor weight gain and/or growth in children, myalgia, arthralgia, psychiatric symptoms, hypotension, hypoglycemia.Children 2 consecutive weeks, >3 cumulative weeks in the last 6 months, or when concerned about long term high doses of ICS.Doses may be repeated at intervals ‘‘according to patient response,’’ and may be adjusted up to 100 mg.Dosages: Initial dose for children is 40 mg, which should be given by deep IM injection into the gluteal muscle.Alternative options include a trial of IM Triamcinolone injections, which may be useful in diagnosing steroid resistance if there is a suspicion of non-adherence:.Treatment duration will depend on need, but durations of >2 weeks of oral steroids require weaning regimens. Commonly used dosing: 1mg/kg oral prednisolone daily or 2 nd daily.Systematic & Multidimensional Assessment Resources.Alternative Diagnosis & Co-Morbidities in Paediatrics.Staffing & Multidisciplinary Team Approach.Cardiovascular Disease & Metabolic Disease.Gastro-oesophageal Reflux Disease (GORD).Interdisciplinary Approach & Multidimensional Assessment.Severe Asthma Attacks / Exacerbations / Flare-ups.
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