9b. Clinical features of Asthma in Children Flashcards
If there is no wheeze then there is no…
Asthma
If there is no wheeze in a child there is no asthma
What is asthma?
Literally “panting” Chronic Wheeze, cough and SOB Multiple triggers URTI, exercise, allergen, cold weather, etc Variable/reversible Responds to asthma Rx NO UNIFORM DEFINITION
What is the most prevalent cause of asthma?
The cold
Key words in asthma
- Wheeze
- Variability
- Respond to treatment
What are the similarities between adults and children?
- Symptoms
- Common
- Same triggers
- Same treatment
- Same pathology
What are the differences between adults and children?
Gender (Boys and Women)
Severe asthma
Occupation asthma uncommon
What is the % of children on inhaled steroids?
5%
What are the multiple hits of asthma?
- Genes
- Inherently abnormal lungs
- Early onset atopy
- Later exposures
- Rhinovirus
- Exercise
- Smoking
What are the many inconsistencies?
“Transient” vs persistent Different severities Different age at onset Heterogeneity in response Different triggers
When is it asthma?
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
What is the significance of a wheeze?
A “must have”
Cough variant asthma does not exist
Cough predominant asthma not uncommon
What are the three words used to describe a wheeze?
Rattle
Stretor
Stridor
SOB at rest
Significant resp difficulty
<30% lung function
Airway obstruction
Sucking in of ribs with wheeze
Cough
Everyone coughs!
Dry
Nocturnal (just after falling asleep)
Exertional
Atopy
Does not “cause” asthma - Atopy and asthma secondary to same process - URTI primary precipitant Personal history - Eczema - Hayfever - Food allergies Family history
What is a major cause of asthma?
Rhinovirus
What is an asthma treatment?
ICS for 2 months
What is the treatment of infrequent episodic wheeze with a cold?
Salbutamol
When is it not asthma?
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
What could it be when it’s not asthma?
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
What is Bronchitis?
Common ++++ Not described Loose rattly cough Noisy breathing Post-tussive vomit - “glut” Child VERY well, parent worried Chest free of wheeze/creps Self-limiting
What is the mechanism of Bacterial Bronchitis?
Disturbed mucociliary clearance - RSV/adenovirus/rhinovirus - Haemophilus culture medium - ≥4 week recovery Infection secondary Lack of social inhibition
What is the natural history of Bacterial Bronchitis?
Following URTI Lasts 4 weeks 60-80% respond First winter bad Second winter better Third winter fine Pneumococcus/H flu
What is Pertussis?
This is common! Vaccination reduces risk Vaccination reduces severity “Coughing fits” Vomiting, colour change, petechiae
