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Systems: Resp. WK > 9. Paediatric asthma: clinical features > Flashcards

9. Paediatric asthma: clinical features Flashcards

1
Q

What sign is VITAL for asthma diagnosis?

A

Wheeze (no wheeze= no asthma!!!)

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2
Q

What are main features of asthma? (6)

A
  1. chronic
  2. wheeze, cough and dyspnea (short of breath)
  3. variable/reversible over time
  4. literally “panting”
  5. no uniform definition (when other diagnoses have been excluded)
  6. can have multiple triggers (URTIs such as viruses, exercise, allergens, cold weather etc)
  7. ALWAYS responds to asthma medicine/treatment/prescription
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3
Q

What are the 3 most important phrases associated with asthma?

A
  1. wheeze
  2. variability
  3. respond to treatment (asthma treatment)
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4
Q

What are 5 similarities between adult asthma and paediatric asthma?

A
  1. symptoms
  2. common
  3. same triggers
  4. same treatment
  5. same pathology
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5
Q

What often doesn’t appear in asthmatic children that is a common symptom in adults?

A

cough

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6
Q

What are the RBM (reticular basement membrane) changes in asthmatic children?

A

it’s more clumped whereas adult asthma is more spread out (similar pathological changes arise)

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7
Q

In children, is asthma more common among males or females?

A

males

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8
Q

In adults, is asthma more common among males or females?

A

females; especially women over 40 and elderly

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9
Q

What are the 3 main differences between adult and paediatric asthma?

A
  1. gender (boys not women)
  2. severe asthma (child asthma often burns out by the time child gets to adulthood)
  3. occupational asthma uncommon
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10
Q

How many children in UK and Scotland suffer from asthma?

A
  • 1 million in UK

- 100,000 in Scotland

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11
Q

What percentage of UK children are on inhaled steroids?

A

5%! (1 in 20 children in UK suffer from asthma)

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12
Q

What 5 common pathways lead to asthma development? (the aetiology/causation of asthma)

A
  1. infant onset
  2. childhood onset
  3. adult onset
  4. exceptional asthma
  5. occupational asthma
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13
Q

Does asthma require “multiple hits” to start developing?

A

Yes (all 5 common pathways have one common pathway) in similar way to cancer, heart disease etc.

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14
Q

How do we know all aetiology pathways lead to asthma?

A

all lead to the same symptoms, triggers, medication and pathologies

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15
Q

What are the 4 main “multiple hits” needed to combine with the leading pathway to develop asthma?

A
  1. genes
  2. inherently abnormal lungs
  3. early onset atopy/ predisposition
  4. later exposures (rhinovirus, exercise, smoking)
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16
Q

Can asthma appear spontaneously?

A

Some people might have potential for asthma and develop it due to; age, stress, occupation

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17
Q

What are the 5 main inconsistencies with asthma?

A
  1. transcient vs persistent (can be both)
  2. different severities
  3. different age at onset
  4. heterogeneity in response
  5. different triggers
    (many phenotypes exist)
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18
Q

What is meant by “sum of multiple hits”?

A

Treshold for symptoms needs to be reached to develop asthma (e.g. combination of various factors such has environment, atopy, lung infection etc)

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19
Q

Is examination helpful when diagnosing asthma?

A

no

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20
Q

Where is most of the asthma diagnosis made?

A

in the patient history (stethoscope not really important)

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21
Q

Is there a specific test to diagnose asthma?

A

No, it has an EPISODIC nature;

  • peak flow=can be useful but variability doesn’t always indicate asthma
  • allergy tests=irrelevant
  • spirometry=lacks specificity
  • exhaled NO= unproved
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22
Q

Why are allergy tests seen as “unreliable” at times?

A

Only 1 in 4 people with a positive allergy test have asthma (more allergic people who DON’T have asthma than do)

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23
Q

Does peak flow variability always indicate asthma?

A

No

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24
Q

What is a MUST have symptom of asthma?

A

wheezing

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25
Q

Does cough varian asthma exist?

A

no, it doesn’t exist

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26
Q

Is cough predominant asthma common?

A

quite common

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27
Q

What is the mechanism for the wheeze in asthma?

A
  • caused by turbulent airflow

- bronchoconstriction and airway wall thickening (due to inflammation) mixes with luminal secretions creating the noise

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28
Q

Why are children’s airways more likely to wheeze?

A

Because they are smaller so they’re more likely to make a sound

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29
Q

What percentage of reported wheezes are not really wheezes but rattles, stertors or stridors?

A

> 55% “suspected” wheezes ( in Aberdeen alone 75% 2 year old wheezes are not genuine)

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30
Q

What does shortness of breath indicate about airways?

A
  • airway obstruction
  • significant respiratory difficulty with <30% lung function
  • sucking in of ribs with wheeze (diaphragm sucks in air desperately from narrowed airways)
  • very abnormal
31
Q

What is cough like in asthmatic children?

A
  • dry
  • nocturnal (just after falling asleep)
  • exertional (brought on by exercise)
  • not relied on too much as a symptom as everyone coughs for various reasons
32
Q

What are 6 most common multiple triggers which combine to increase likelihood of developing asthma?

A
  1. URTI (rhinovirus in 75%)
  2. exercise
  3. allergen
  4. cold air
  5. emotion
  6. menstruation
33
Q

Does atopy (genetic predisposition) cause asthma?

A

Not cause, but contributes to it. Atopy and asthma are secondary to the same process

34
Q

What is the primary precipitant to asthma (not atopy)?

A

URTIs

35
Q

Past medical history of which conditions contribute to the atopy aspect of asthma? (3)

A
  1. eczema
  2. hayfever
  3. food allergies
36
Q

What is the most common asthma treatment and for how long?

A

inhaled corticosteroids (ICS) for 2 months

37
Q

What are the 6 main signs of asthma?

A
  1. wheezing
  2. dyspnea at rest
  3. cough
  4. multiple triggers
  5. atopy
  6. responds to treatment
38
Q

What are common differential diagnoses for asthma? ( conditions which need to be ruled out and considered and which have a lot of common respiratory symptoms) (9)

A
  1. viral induced wheeze
  2. foreign body
  3. cystic fibrosis (produce secretions)
  4. immune deficiency (produce secretions)
  5. cilliary dyskinesia (produce secretions)
  6. tracheo-bronchomalacia
  7. aspiration
  8. gastro-eosophageal reflux
  9. hole between trachea and oesophagus
39
Q

Do viral induced wheeze and asthma have similar correlations?

A

Yes; (they are both transient; sometimes better and sometimes worse)

40
Q

What are some similar features of asthma and viral induced wheeze?

A
  1. affects preschool children (99%)
  2. different shades of the same colour
  3. child doesn’t care what you call it because the same symptoms
41
Q

What are the main questions to consider when treating a child with asthma and administering the treatment plan? (4)

A
  • should it be treated?
  • how is it affecting the child’s life?
  • how is it affecting the parent’s life?
  • is it necessary?
42
Q

What is the treatment of infrequent episodic wheeze with a cold?

A

Salbutamol; based on evidence based medicine (frequent in pre-school kids)

43
Q

What could the condition be that is NOT a genuine wheeze?

A
  • rattle
    -stertor
    (requires different treatment to asthma)
44
Q

What could the condition/s be that does NOT respond to treatment?

A

small print (various respiratory conditions)

45
Q

What if the condition has a genuine wheeze AND responds to treatment?

A

asthma

46
Q

Is asthma likely in a child under 18 months of ago?

A

No, most likely an infection

47
Q

Is asthma likely in a child over the age of 5 years?

A

Yes, most likely asthma

48
Q

What is the general rule linking asthma and responding to treatment together?

A

If it sounds like asthma AND responds to asthma- it’s asthma regardless of age

49
Q

What type of cough is not likely to be asthma?

A

Isolated cough

50
Q

What conditions have isolated cough as their symptom?

A
  1. bronchitis
  2. pertussis
  3. habitual cough
  4. tracheomalacia
  5. small print as per wheeze (cystic fibrosis, foreign bodies, immune deficiency, primary cilliary diskinesia)
51
Q

What age range does bronchitis often affect and what cough type does it cause?

A
  • 2-3 year olds

- wet cough

52
Q

What age range does pertussis affect and what are its common symptoms? (3)

A
  • any age

- fits, vomit and haematoma

53
Q

What age range does habitual cough affect and what cough type does it cause?

A
  • 8-12 year old

- single loud cough

54
Q

What type of cough does tracheomalacia cause?

A

life long loud cough

55
Q

Describe some common features of bronchitis.

A
  • VERY common
  • loose rattly cough (wet)
  • noisy breathing
  • post-tussive vomit (glut)
  • child VERY well but worried parent
  • chest free of wheeze/creps
  • self-limiting
  • it can take months to go away
56
Q

What causes bacterial bronchitis?

A
  • Disturbed mucociliary clearance (cilia don’t move mucus in airways)
  • secretions are not removed
57
Q

What 3 viruses can often lead to and predispose the child to bacterial bronchitis?

A
  1. RSV
  2. adenovirus
  3. rhinovirus
58
Q

What can cause a secondary infection in bacterial bronchitis patients?

A

haemophilus culture medium

59
Q

How long does the recovery taken for a secondary infection?

A

approx. 4 week recovery

60
Q

Bacterial bronchitis tends to follow what types of infections?

A

Upper Respiratory Tract Infections (URTIs)

61
Q

How long does bacterial bronchitis last for?

A

approx. 4 weeks

62
Q

What percentage of patient respond effectively to treatment for bacterial bronchtitis?

A

60-80%

63
Q

Does bacterial bronchitis get better over time?

A

Yes; morbidities decreasing every winter

64
Q

What is the disadvantage of NOT treating bacterial bronchitis?

A

Self-limiting

65
Q

What is the disadvantage of treating bacterial bronchitis?

A
  • quality of life

- risk of diarrhoea

66
Q

What is another name for pertussis?

A

whooping cough (very common)

67
Q

What are 2 main advantages of pertussis vaccine?

A
  • vaccine reduces risk

- vaccine reduces severity

68
Q

What are some common symptoms of pertussis?

A
  • coughing fits
  • vomiting
  • colour change
  • petechiae(red spot due to bleeding into the skin)
  • burst blood vessels in the face
69
Q

How many people who are vaccinated against pertussis can still get it?

A

1 in 500

70
Q

Is there an asthma test?

A

NO ( no test for adults or children)

71
Q

Can you cure asthma?

A

NO; just relieve the symptoms by managing the condition

72
Q

How can an asthma diagnosis be confirmed? (2)

A
  1. no wheeze= no asthma

2. trial with inhaled corticosteroids

73
Q

Is there a lower age limit for diagnosing asthma?

A

No

Systems: Resp. WK (40 decks)

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