9b. Clinical features of Asthma in Children

Question 1

If there is no wheeze then there is no…

Answer 1

Asthma

If there is no wheeze in a child there is no asthma

Question 2

What is asthma?

Answer 2

Literally “panting”
Chronic
Wheeze, cough and SOB
Multiple triggers
URTI, exercise, allergen, cold weather, etc
Variable/reversible
Responds to asthma Rx
NO UNIFORM DEFINITION

Question 3

What is the most prevalent cause of asthma?

Answer 3

The cold

Question 4

Key words in asthma

Answer 4

• Wheeze
• Variability
• Respond to treatment

Question 5

What are the similarities between adults and children?

Answer 5

1. Symptoms
2. Common
3. Same triggers
4. Same treatment
5. Same pathology

Question 6

What are the differences between adults and children?

Answer 6

Gender (Boys and Women)
Severe asthma
Occupation asthma uncommon

Question 7

What is the % of children on inhaled steroids?

Answer 7

5%

Question 8

What are the multiple hits of asthma?

Answer 8

1. Genes
2. Inherently abnormal lungs
3. Early onset atopy
4. Later exposures
   - Rhinovirus
   - Exercise
   - Smoking

Question 9

What are the many inconsistencies?

Answer 9

“Transient” vs persistent 
Different severities
Different age at onset
Heterogeneity in response
Different triggers

Question 10

When is it asthma?

Answer 10

ALL IN THE HISTORY
Examination unhelpful
- Unlikely to be wheezing
- Stethoscope never important
No asthma test
- Peak flow random number generator
- Allergy tests irrelevant
- Spirometry lacks specificity
- Exhaled nitric oxide unproven

Question 11

What is the significance of a wheeze?

Answer 11

A “must have”
Cough variant asthma does not exist
Cough predominant asthma not uncommon

Question 12

What are the three words used to describe a wheeze?

Answer 12

Rattle
Stretor
Stridor

Question 13

SOB at rest

Answer 13

Significant resp difficulty
<30% lung function
Airway obstruction
Sucking in of ribs with wheeze

Question 14

Cough

Answer 14

Everyone coughs!
Dry
Nocturnal (just after falling asleep)
Exertional

Question 15

Atopy

Answer 15

Does not “cause” asthma
- Atopy and asthma secondary to same process
- URTI primary precipitant
Personal history
- Eczema
- Hayfever
- Food allergies
Family history

Question 16

What is a major cause of asthma?

Answer 16

Rhinovirus

Question 17

What is an asthma treatment?

Answer 17

ICS for 2 months

Question 18

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

Answer 18

Salbutamol

Question 19

When is it not asthma?

Answer 19

All that is chronic and paediatric and respiratory is not asthma
Simplistically
- Under 18 months, most likely infection
- Over 5 years, most likely asthma
- BUT if it sounds like asthma and responds to asthma it is asthma regardless of age

Question 20

What could it be when it’s not asthma?

Answer 20

Isolated cough
- Bronchitis (2-3 year old, wet cough)
- Pertussis (any age, fits, vomit, haematoma)
- Habitual cough (8-12 year old, single loud cough)
- Tracheomalacia (life long loud cough
- Small print as per wheeze
_CF, FB, ID, PCD

Question 21

What is Bronchitis?

Answer 21

Common ++++
Not described
Loose rattly cough
Noisy breathing
Post-tussive vomit - “glut”
Child VERY well, parent worried
Chest free of wheeze/creps
Self-limiting

Question 22

What is the mechanism of Bacterial Bronchitis?

Answer 22

Disturbed mucociliary clearance
- RSV/adenovirus/rhinovirus
- Haemophilus culture medium
- ≥4 week recovery
Infection secondary
Lack of social inhibition

Question 23

What is the natural history of Bacterial Bronchitis?

Answer 23

Following URTI
Lasts 4 weeks
60-80% respond 
First winter bad
Second winter better
Third winter fine
Pneumococcus/H flu

Question 24

What is Pertussis?

Answer 24

This is common!
Vaccination reduces risk
Vaccination reduces severity
“Coughing fits”
Vomiting, colour change, petechiae

Question 25

What is the poem for Asthma?

Answer 25

If you think it’s asthma
But you are not sure,
Give a short course of inhaled steroids
And see if you have a cure!

Question 26

What are the main points?

Answer 26

No wheeze, no asthma
No asthma test
Confirm the diagnosis with trial of ICS
No lower age limit for diagnosing asthma