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Paediatrics > 1: Resp - Asthma > Flashcards

1: Resp - Asthma Flashcards

1
Q

What is asthma

A

Chronic disease with airway inflammation, bronchial hyper-reactivity and reversible airway obstruction

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2
Q

What age will the majority of cases of childhood asthma present before

A

10y

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3
Q

Give 5 triggers for asthma

A
  • Exercise
  • Dust mite
  • Smoking
  • Viruses
  • Pollen
  • Fur/Feathers
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4
Q

What are 5 risk factors for asthma

A
  • FH
  • Low birth weight
  • Parents smoking
  • Bottle fed
  • ADAMS33 gene
  • History eczema or allergic rhinitis
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5
Q

How will asthma present in a child

A
  • Dyspnoea
  • Nocturnal cough
  • Chest tightness
  • Expiratory wheeze
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6
Q

In which age-group is breathlessness more common

A

Pre-School

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7
Q

What type of asthma do children typically have

A

Exercise-Induced

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8
Q

What are three signs of long-standing asthma

A
  • Barelled chest
  • Polyphonic expiratory wheeze
  • Harrison Sulci
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9
Q

What is a Harrison sulci

A

If asthma is present during infancy, there will be a horizontal line along lower border of the thorax due to costal insertion of diaphragm

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10
Q

What is first-line investigation for asthma

A

Spirometry and Bronchodilator Reversibility Testing

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11
Q

When is spirometry with reversibility suitable

A

Children >5Y

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12
Q

What is a positive test with spirometry and bronchodilator reversibility

A

Improvement in FEV1 >12% with bronchodilator

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13
Q

What does a negative test in spirometry and bronchodilator reversibility mean

A

Does not exclude a diagnosis of asthma

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14
Q

When is spirometry and bronchodilator reversibility not suitable

A

If a child is under 5

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15
Q

What is second-line investigation in children with asthma

A

Peak Expiratory Flow

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16
Q

What is a positive result on peak expiratory flow

A

Diurnal variability of more than 20%

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17
Q

What does a ‘negative’ peak expiratory flow result mean

A

Does not exclude a diagnosis of asthma

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18
Q

What is third-line investigation for asthma

A

Direct Challenge Test

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19
Q

What is the direct challenge test

A

Histamine or Methacholine are administered at increasing doses. The dose at which a 20% reduction in FEV1 is noted

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20
Q

What is a positive test

A

Concentration <8 required to reduce FEV1 by 20%

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21
Q

What does a negative methacholine challenge test mean

A

In schoolchildren, a negative methacholine test makes a diagnosis of asthma unlikely

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22
Q

What is the exercise challenge

A

Fall in FEV1 of 15% on exercising

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23
Q

What does a positive exercise challenge indicate

A

Highly indicates asthma in school-aged children

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24
Q

When can FeNO only be performed

A

Children >3-4Y

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25
Q

What FeNO is a positive test in children

A

> 35ppb

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26
Q

What FeNO is positive in adults

A

> 40ppb

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27
Q

Why may a skin prick test be performed

A

to look for atopy

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28
Q

How does a positive skin prick test affect the probability of the condition being asthma

A

increases probability it is asthma in school children

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29
Q

Following clinical assessment what is first-line investigation in children >5Y

A

Spirometry and bronchodilator reversibility testing

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30
Q

If spirometry and bronchodilator reversibility is positive, what should be done

A

Trial of treatment and repeat LFTs

31
Q

If spirometry and bronchodilator reversibility are negative, what should be done

A

FeNO or Direct Challenge Test

32
Q

What is the problem with diagnosing asthma in children under 5

A

Cannot undergo spirometry

33
Q

Describe how asthma is diagnosed in under 5Y

A
  • Watchful waiting and review

- Monitored initiation of treatment

34
Q

What is first-line management for 5-16Y with asthma

35
Q

What is second line for 5-16Y with asthma

A

Very Low Dose Paediatric Corticosteroids

36
Q

What is third line for 5-16Y with asthma

A

LTRA or LABA

37
Q

What is fourth-line management of 5-16Y with asthma

A

Increase dose to low dose inhaled corticosteroids

38
Q

What is fifth-line management of 5-16Y with asthma

A

Specialist

39
Q

What is first line asthma management in children under 5

40
Q

What is second line asthma management in children under 5

A

LTRA

Or v.low dose paediatric ICS

41
Q

what is third line asthma management in children under 5

A

Very Low Dose Paediatric ICS

LTRA

42
Q

what is fourth-line asthma management in children under 5

43
Q

what is fifth-line asthma management in children under 5

A

Specialist

44
Q

what type of inhaler should children under 5 be offered

A

MDI with spacer

45
Q

what type of inhaler should children 5-12Y be offered

A

MDI with spacer of dry-powered inhaler

46
Q

What agent is preferred to treat asthma is atopic history

47
Q

How will asthma present in pre-school children (0-3)

A

Recurrent wheezing often triggered by viral upper airway infection

48
Q

How will asthma present in school children (5-12)

A
  • Nocturnal Cough
  • Exercise- Induced Cough
  • Chest tightness
  • Wheeze
49
Q

What often causes asthma attacks in Children

A

Viral illness leading to recurrent wheeze

50
Q

How are asthma attacks graded in children

A
  • Moderate
  • Acute severe
  • Life-threatening
51
Q

What are 5 features of moderate acute asthma attack in children <5Y

A
  1. Able to talk in full sentences
  2. SpO2 > 92%
  3. PEFR >50%
  4. HR (depends on age)
  5. RR (depends on age)
52
Q

What is the HR in moderate asthma attack in

a. Children 1-5y
b. Children >5y

A

a. <140bpm

b. <125bpm

53
Q

What is the RR in moderate asthma attack in

a. Children 1-5y
b. Children >5y

A

a. <40

b. <30

54
Q

What are 5 features of acute severe asthma in children

A
  1. Unable to talk in full sentences
  2. SpO2 <92%
  3. PEFR: 33-50
  4. HR (age-dependent)
  5. RR (age-depdentent)
55
Q

In acute severe asthma, what is the HR if

a. 1-5
b. >5

A

a. >140

b. >125

56
Q

In acute severe asthma, what is the RR if

a. 1-5
b. >5

A

a. >40

b. >30

57
Q

What are 6 signs of life-threatening asthma

A
  • Exhaustion
  • Cyanosis
  • Hypotension
  • Silent chest
  • Poor respiratory effort
  • Confusion
58
Q

What are two measurements in life-threatening asthma

A
  • PEF <33

- SpO2 <92

59
Q

What is first-line management of an asthma attack in children

A

Salbutamol

60
Q

How is salbutamol given in a moderate asthma attack

A

Via spacer and face mask

61
Q

How is salbutamol given in acute severe or life-threatening asthma

62
Q

What dose of salbutamol is given

A

2.5mg via oxygen-driven nebuliser

63
Q

What is second-line management of asthma attack in children

A

Ipratropium Bromide

64
Q

What dose of ipratropium bromide is given

A

250 micrograms

65
Q

What is third-line management of asthma attack in children

A

Oral prednisolone

66
Q

What dose of oral prednisolone is given if

a. <2Y
b. 2-5Y
c. >5Y

A

a. 10mg
b. 20mg
c. 30-40mg

67
Q

How long is oral prednisolone continued for

A

3 Days post asthma attack

68
Q

What may be given in acute severe or life-threatening asthma

A

Nebulised Magnesium Sulphate

69
Q

What dose of magnesium sulphate is given

70
Q

If child is not responding to asthma management, what is given

A

IV Salbutamol
IV aminophylline
IV magnesium

71
Q

What are three requirements prior to discharge in child with asthma

A

PEF >75%
Asthma action plan
Inhaler technique checked

72
Q

When is a child followed up

a. at the GP, b. in clinic following an asthma attack

A

a. 1W

b. 4W

73
Q

How old does a child need to be to be diagnosed with asthma

Paediatrics (61 decks)

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