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3: Paeds Y3/4 - Paediatrics [15] > [3] Asthma > Flashcards

[3] Asthma Flashcards

1
Q

How is asthma defined?

A

As an episodic, reversible, intrathoracic airway obstruction

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2
Q

When does the reversibility occur in asthma?

A

May occur spontaneously, or because of therapy

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3
Q

What are the symptoms of asthma caused by?

A

Narrowing of bronchi and bronchioles

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4
Q

What causes the narrowing of bronchi and bronchioles in asthma?

A

Bronchoconstriction, mucosal swelling, and viscous secretions obstructing the lumen

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5
Q

What initiates the process of airway narrowing in asthma?

A

Various allergic and non-specific stimuli

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6
Q

How do various allergic and non-specific stimuli initiate the process of airway narrowing in susceptible individuals?

A

By triggering the release of histamine and other mediators

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7
Q

What stimuli can trigger the process of airway narrowing in asthma?

A
  • Dust mites
  • Air pollutants
  • Cigarette smoke
  • Cold air
  • Viral infections
  • Stress
  • Exercise
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8
Q

What is atopic asthma?

A

When recurrent wheezing is associated with interval symptoms, and there is evidence of allergy to one or more inhaled allergens, e.g. house dust mites, pollen, or pets

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9
Q

What is atopic asthma strongly associated with?

A

Other atopic disease, e.g. eczema, rhinoconjuncitivitis, and food allergy

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10
Q

What are the risk factors for asthma?

A
  • Allergies
  • Family history of allergies/asthma
  • Frequent respiratory infections
  • Low birth weight
  • Second-hand smoke before and/or after birth
  • Growing up in a low income, urban environment
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11
Q

When should you suspect asthma in a child?

A

When there is wheezing on more than one occasion, particularly if there are interval symptoms.

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12
Q

Describe an asthmatic wheeze?

A

Polyphonic (multiple pitch) noise coming from the airways

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13
Q

What are the key features are associated with a high probability of asthma?

A
  • Symptoms worse at night and in early morning
  • Symptoms that have non-viral triggers
  • Interval symptoms
  • Personal or family history of atopic disase
  • Positive response to asthma therapy
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14
Q

What are interval symptoms?

A

Symptoms that occur between acute exacerbations

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15
Q

What should be further explored once a diagnosis of asthma is firmly suspected?

A

The pattern or phenotype

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16
Q

What questions should be asked to determine the pattern or phenotype of asthma?

A
  • How frequent are the symptoms?
  • What triggers the symptoms?
  • How often is sleep disturbed?
  • How severe are the interval symptoms between exacerbations
  • How much school has been missed due to asthma?
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17
Q

What is found on examination of the chest between attacks?

A

It is usually normal

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18
Q

What may be found on examination in long-standing asthma?

A
  • Hyperinflation of the chest
  • Generalised polyphonic expiratory wheeze
  • Prolonged expiratory phase
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19
Q

What should be done regarding growth in asthma?

A

Growth should be plotted

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20
Q

What is normally found regarding growth in asthma?

A

It is usually normal unless asthma is extremely severe

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21
Q

What other conditions should be checked for in asthma?

A

Other atopic conditions, e.g. eczema, nasal mucosa examination

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22
Q

What might suggest an alternative diagnosis to asthma?

A

Presence of features such as wet cough or sputum production, finger clubbing, or poor growth

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23
Q

What does the presence of features such as wet cough, sputum production, finger clubbing, or poor growth suggest?

A

A condition characterised by chronic infection, e.g. cystic fibrosis or bronchiectasis

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24
Q

How is asthma diagnosed in younger children?

A

Usually from history and examination alone

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25
Q

Why are specific investigations sometimes required in asthma?

A
  • Confirm diagnosis

- Determine severity and phenotype in more detail

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26
Q

What specific investigations may be used in asthma?

A
  • PEFR

- Spirometry

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27
Q

What is often the most useful investigation in asthma?

A

Peak flow and spirometry before and after bronchodilator

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28
Q

What finding on peak flow/spirometry before and after bronchodilator is characteristic of asthma?

A

An improvement of 12% or more, confirming bronchodilator reversibility

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29
Q

What often happens to bronchodilator reversibility in asthma after treatment?

A

It reduces or disappears completely

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30
Q

What is peak flow?

A

A person’s maximum speed of expiration

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31
Q

What is a peak flow meter?

A

A small, hand-held device used to monitor a person’s ability to breathe out air

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32
Q

What are the advantages of peak flow?

A
  • Helpful for serial measurements
  • Portable
  • Can be used to assess how well asthma is controlled
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33
Q

Why can peak flow be used to assess how well asthma is controlled?

A

Because poorly controlled asthma leads to increased variability in peak flow, with both diurnal variability and day-to-day variability

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34
Q

What diurnal variability is there in poorly controlled asthma?

A

Peak flow is usually lower in the morning than the evening

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35
Q

What does spirometry involve?

A

The measurement of forced expiratory volume in 1 second

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36
Q

How is forced expiratory volume measured?

A

The patient has to breathe out as hard and fast as possible

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37
Q

What are the advantages of spirometry?

A
  • Provides non-invasive measure of flow through larger airways
  • Better than peak flow at detecting changes in airway calibre
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38
Q

Why might skin-prick testing for common allergens be done in asthma?

A
  • Aid diagnosis of atopy

- Identify allergens which may be acting as triggers

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39
Q

What are the differential diagnoses of asthma?

A
  • Bronchiolitis
  • Viral wheeze
  • Cystic fibrosis
  • Recurrent anaphylaxis
  • Chronic aspiration
  • Bronchopulmonary dysplasia
  • Bronchiolitis obliterans
  • Tracho-bronchomalacia
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40
Q

What it the aim of asthma management?

A

Complete symptom control

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41
Q

What is complete symptom control in asthma management defined as?

A
  • Absence of daytime or nighttime symptoms
  • No limit on activities, including exercise
  • No need for reliever use
  • Normal lung function
  • No exacerbations (need for hospitalisation or oral steroids) in previous 6 months
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42
Q

How is the treatment of asthma determined?

A

It increases from step 1 to step 5, stepping down when control is good

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43
Q

What is step 1 in asthma management?

A

Inhaled short acting ß2 agonist as required

44
Q

What are short acting ß2 agonists often called?

A

Relievers

45
Q

Give two examples of short acting ß2 agonists

A
  • Salbutamol

- Terbutaline

46
Q

After how long is the maximum effect of ß2 agonists?

A

After 10-15 mins

47
Q

How long are short acting effective for?

A

2-4 hours

48
Q

On what basis are short acting ß2 agonists used in asthma?

A

‘As required’ for increased symptoms

They can also be used in high doses for acute asthma attacks

49
Q

What does the device in which inhaled drugs are administered chosen based on?

A

Child’s age and preference

50
Q

What devices can be used to administer inhaled drugs?

A
  • Pressured metered dose inhaler (and spacer)
    Breath-actuated metered dose inhalers
  • Dry powder inhalers
  • Nebulisers
51
Q

What age group are pressured metered dose inhalers suitable for?

A

All age groups

52
Q

What should children aged 0-2 years be given with a pressured metered dose inhaler?

A

Space and face mask

53
Q

When is a spacer used with a metered dose inhaler?

A

Recommended for all children, but definitely needed in children >3 years

54
Q

Why are spacers recommended for all children?

A
  • Increases drug depositions for lungs

- Reduced oropharyngeal deposition

55
Q

What is the advantage of reduced oropharyngeal deposition?

A

It reduces side effects when using a steroid inhaler

56
Q

Why are spacers useful in acute asthma attacks?

A

Because poor inspiratory effort may impair the use of inhalers directly into the mouth

57
Q

Who can breath-actuated metered dose inhalers be used in?

A

Children 6+ years

58
Q

What is the advantage of breath-actuated metered dose inhalers?

A

Less co-ordination is required then with a pressured metered dose inhaler without a spacer

59
Q

What is the result of breath-actuated metered dose inhalers not requiring a spacer?

A

They are good when ‘out and about’ in older children

60
Q

What age group are dry powder inhalers useful in?

A

4+ years

61
Q

When are dry powder inhalers not good?

A
  • Severe asthma

- Acute attack

62
Q

Why are dry powder inhalers not good in severe asthma or acute attacks?

A

Because they need a good inspiratory flow

63
Q

What age group are nebulisers used in?

A

Any age

64
Q

When are nebulisers used?

A

Only in acute asthma, when oxygen is required in addition to inhaled drugs

65
Q

When can nebulisers be used at home?

A

Occasionally as part of an acute management plan in those with rapid-onset severe asthma

66
Q

What is ipratropium bromide?

A

An anti-cholinergic bronchodilator

67
Q

What is ipratropium bromide used for?

A

Sometimes given to young infants when other bronchodilators are found to be ineffective, or in treatment of acute severe asthma

68
Q

What is step 2 in asthma management?

A

Regular preventer therapy

69
Q

What is the most effective inhaled preventer therapy?

A

Inhaled corticosteroids

70
Q

What is the action of inhaled corticosteroids?

A

Decrease airway inflammation, resulting in decreased symptoms, asthma exacerbations, and bronchial hyperactivity q

71
Q

What are the side effects of low-dose inhaled corticosteroids?

A

They have no clinically significant side effects when given in low dose, although they cause a mild reduction in height velocity, which is usually followed by a catch-up growth in late childhood

72
Q

What are the side effects of high-dose inhaled corticosteroids?

A

Systemic side effects, such as impaired growth, adrenal suppression, and altered bone metabolism

73
Q

How are the side effects of inhaled corticosteroids minimised?

A

Treatment should always be at lowest dose possible

74
Q

What is step 3 in asthma management?

A

Initial add on therapy

75
Q

What is the first-choice add on therapy in children under 5?

A

An oral leukotriene receptor antagonist

76
Q

Give an example of an oral leukotriene receptor antagonist

A

Montelukast

77
Q

What is the first-choice initial add on therapy in children over 5?

A

LABA (long-acting ß-agonists)

78
Q

What should be done following giving the first-choice initial add on therapy?

A

Assess response

79
Q

What should be done if good response to initial add on therapy in over 5’s?

A

Remain as is

80
Q

What should be done if there is a partial response to initial add on therapy in over 5’s?

A

Increase ICS dose

81
Q

What should be done if there is poor response to initial add on therapy in over 5’s?

A

Stop LABA and increase ICS dose. Consider oral leukotriene receptor antagonist, and/or slow release theophylline

82
Q

Give 2 examples of LABAs

A
  • Salmeterol

- Formoterol

83
Q

How long are LABAs effective for?

A

12 hours

84
Q

When should LABAs not be used?

A
  • Acute asthma

- Without inhaled corticosteroids

85
Q

When are LABAs particularly useful?

A

In exercise-induced asthma

86
Q

What is step 4 in asthma management?

A

Persistent poor control

87
Q

What should be done when there is persistent poor control in <5 year olds?

A

Refer to respiratory paediatrician

88
Q

What should be done when there is persistent poor control in 5-12 year olds?

A

Increase ICS dose

89
Q

What should be done when there is persistent poor control in adolescents and young adults?

A

Increase ICS and consider leukotriene receptor antagonists, or slow release theophylline

90
Q

What is step 5 in asthma management?

A

Continuous or frequent use of oral steroids

91
Q

What inhaled steroid dose should be used in step 5 in 5-12 year olds?

A

You should maintain inhaled steroid dose at 800μg/day

92
Q

What oral steroid dose should be used in step 5 in 5-12 year olds?

A

Use lowest possible dose to maintain adequate control

93
Q

What should be done in addition to giving steroids in step 5 management in 5-12 year olds?

A

Refer to respiratory paediatrician

94
Q

What inhaled steroid dose should be used in step 5 in adolescents and young adults?

A

1600μg/day

95
Q

When is oral prednisolone given in step 5 asthma management?

A

Alternate days

96
Q

Why is oral prednisolone given on alternate days in step 5 asthma management?

A

To minimise the adverse effect on growth

97
Q

Who should all children on oral steroid therapy for asthma be managed by?

A

A specialist in childhood asthma

98
Q

Give an example of an anti-IgE therapy used in asthma

A

Omalizumab

99
Q

Who can administer anti-IgE therapy with omalizumab in asthma?

A

Only a specialist in childhood asthma

100
Q

What is omalizumab?

A

An injectable monoclonal antibody that acts against IgE, which is the natural antibody that mediates allergy

101
Q

What is omalizumab used for?

A

The treatment of severe atopic asthma

102
Q

Are antibiotics useful in asthma?

A

Most antibiotics are of no value in the absence of bacterial infection

103
Q

Are cough medicines and decongestants useful in asthma?

A

No

104
Q

Are anti-histamines useful in asthma?

A

No, but useful in treatment of allergic rhinitis

105
Q

What are the complications of asthma?

A
  • Acute asthma exacerbations
  • Permanent narrowing of airways
  • Missed school days or getting behind in school
  • Poor sleep and fatigue
  • Symptoms that interfere with sports, play, or other activities

3: Paeds Y3/4 - Paediatrics [15] (115 decks)

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