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Paediatric - Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is Asthma?

A
  • Asthma is the commonest chronic condition in children
  • It is reversible + paroxysmal constriction of the airways
  • intermittent obstruction and hyper-reactivity
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2
Q

What is the Pathophysiology of Asthma?

A
  • Type 1 hypersensitivity reaction
  • Allergens are presented to these cells by dendritic cells which in these individuals leads to a disproportionate immune response
  • The Th2 cells are activated by dendritic cells and cytokines are released causing increased proliferation of mast cells, eosinophils and dendritic cells
  • IgE activates Mast cells which release Histamine and Leukotriene C4
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3
Q

What are the Risk Factors for developing Asthma?

A
  • Atopy - Asthma/ Eczema/ Hayfever
  • Genetic Factors
  • Environmental Factors (low birth weight, prematurity, parental smoking)
  • Bronchiolitis in early life
  • Diagnosis of atopic dermatitis
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4
Q

What are the Precipitating Factors of Asthma?

A
  • Cold air and exercise: drying of the airways due to cold air and exercise leads to cell shrinkage causing an inflammatory response
  • Drugs: NSAIDs + Beta-Blockers
  • Exposure to allergens
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5
Q

What are the patterns of wheeze in an asthmatic?

A
  • Infrequent episodic wheezing (discrete episodes last a few days with no interval symptoms)
  • Frequent episodic wheezing (occurs more frequent than infrequent)
  • Persistent wheezing (wheeze and cough most days and may have disturbed nights
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6
Q

What questions would you want to know from the history of Asthma?

A
  • Age at onset of symptoms
  • Frequency of symptoms
  • Severity of symptoms (how many school days missed? Can the chid do PE at school? Can they play with their friends without getting symptoms?)
  • Previous treatments tried
  • Any hospital attendances (A+E or ITU/HDU)
  • Prescence of food allergies
  • Triggers for symptoms - Exercise, cold air, smoke, allergens, pets
  • Disease history - Viral infections, eczema, hayfever
  • Family history of Atopy
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7
Q

When would you see Finger Clubbing in children?

A
  • Cystic Fibrosis
  • Bronchiectasis
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8
Q

What would you find on examination in a patient with Asthma?

A
  • Chest shape (hyperinflated chest = poorly controlled asthma
  • Chest symmetry
  • Breath sounds
  • Presence of crepitations (not suggestive of asthma)
  • Presence of wheeze
  • Examination of throat to assess for tonsillar enlargement: infectious cause?
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9
Q

What investigations would you do for Asthma?

A
  • Spirometry (showing an obstructive picture which is reversible after bronchodilators)
  • Peak Expiratory Flow Rate (PEFR) measure of respiratory function
  • Bronchial Provocation tests (histamine and metacholine) not easy to interpret and require specialist input
  • Exercise testing (exercise induced symptoms
  • Skin Prick testing (serum specific IgE assay to allergens, limited role in diagnosis or management of asthma)
  • Exhaled Nitric Oxide ( NO is produced in bronchial epithelial cells and its production is increased in those with TH2-driven eosinophilic inflammation. Those with Asthma have raised ENO and can be raised in allergic rhinitis
  • Chest X-Ray - a good baseline CXR to have
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10
Q

What describes good symptom control in children with Asthma?

A

full school attendance, no sleep disturbance, <2/week daytime symptoms, no limitation on daily activities, no exacerbations, using salbutamol <2/week, maintaining normal lung function

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11
Q

What is the Maintenance management for people with Asthma?

A
  • 1.SABA (salbutamol)
    1. Add Inhaled Corticosteroids (Beclomethasone)
      -3. Add a LABA (salmeterol/ formeterol)
      -4. Increase dose of Inhaled Corticosteroid
      -5. No response of LABA stop and add a Leukotriene Receptor antagonist (LTRA)
      -6. Persistent poor control = Increase dose of inhaled corticosteroids
      -7. Regular oral steroids - referral to respiratory paediatrician
  • Specialist Care: Omalizumab - monoclonal antibody for IgE and reduces the IgE free in the blood, therefore reducing the IgE mediated response
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12
Q

What are Key General Managment Points:

A
  • Aerosol inhaler devices should be used with a spacer device and inhaler technique should be looked at
  • Always ask about compliance
  • LABA should always be prescribed with an Inhaled Corticosteroid
  • Asthma management plan should be in place
  • Know Fluticasone is twice as potent as Beclometasone
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13
Q

What describes a mild/ moderate Asthma Exacerbation?

A
  • Sp02 >92%
  • RR <30 (over 5’s), RR <40 (under 5’s)
  • No Accessory muscle use
  • Feeding well/ talking in sentences
  • Wheeze (Audible with stethoscope)
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14
Q

What describes a severe Asthma Exacerbation?

A
  • Sp02 <92%
  • PEFR 33-50% predicted
  • RR >30 (over 5’s), RR >40 (under 5’s)
  • Too breathless to feed/ talk
  • HR >125 (over 5’s), >140 (under 5’s)
  • Use of Accessory Muslces
  • Audible Wheeze
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15
Q

What describes a Life-Threatening Asthma Exacerbation?

A
  • Sp02 <92%
  • PEFR <33%
  • Silent Chest
  • Poor respiratory effort
  • Altered Consciousness
  • Agitation/ Confusion
  • Exhaustion
  • Cyanosis
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16
Q

What is the Immediate Managment of an Asthma Exacerbation?

A
  • If Sa02 <94% then consider high flow Oxygen
    MODERATE:
  • SABA (salbutamol) nebulised
  • Ipratropium Bromide (Anti-Muscarinic) added
  • Corticosteroids (5day course of oral prednisolone - if child vomits/ unable to take oral medication IV hydrocortisone should be used
  • ABX if suspected bacterial infection

SEVERE:
- IV Aminophylline infusion
- IV SABA

LIFE-THREATENING:
- IV Magnesium Sulphate infusion
- HDU/ICU
- Intubation

17
Q

What entails the Safe-discharge Criteria?

A
  • Bronchodilators are taken as inhaler device with spacer every 4-hours
  • Monitor the serum Potassium when on salbutamol as it causes potassium to be absorbed from the blood into the cells. It also causes a tachycardia
  • Sa02 >94% in air
  • Inhaler technique assessed
  • Asthma management plan written and explained to parents
  • GP should review the child 2 days after discharge
18
Q

What does the ABG show in an intial Asthma Attack?

A
  • It will show Respiratory Alkalosis due to the tachypnoea, causing a drop in the CO2
19
Q

What does the ABG show in a life-threatening Asthma Attack?

A
  • It will show a Respiratory Acidosis due to the high CO2 this is a very bad sign in asthma
20
Q

How would you monitor the response to treatment in Asthma?

A
  • Resp Rate
  • Resp effort
  • Peak flow
  • 02 sats
  • Chest auscultation
21
Q

What can the child Present with which suggests a Diagnosis of Asthma?:

A
  • Episodic symptoms with intermittent exacerbations
  • Diurnal Variability, typically worse at night and early morning
  • Dry cough and wheeze with SOB
  • Typical Triggers
  • History of Eczema and Hayfever
  • Family History
  • Bilateral Widespread Polyphonic Wheeze
  • Symptoms improve with bronchodilators
22
Q

What is the Medical Therapy for a Child Under 5 years with Asthma?

A
  1. SABA
  2. Low dose corticosteroid OR LTR Antagonist
  3. Add the other option from 2
  4. Refer to a specialist
23
Q

What is the Medical Therapy for a Child between 5-12 years with Asthma

A
  1. SABA
  2. low dose corticosteroid
  3. LABA
  4. Increase corticosteroid to medium dose
  5. Add Leukotriene Receptor Antagonist OR Oral Theophylline
  6. Increase the dose of corticosteroid to high dose
  7. Referral to a specialist.
24
Q

What is the Medical Therapy for a Child Over 12 years with Asthma?

A
  1. SABA
  2. Low dose corticosteroid
  3. LABA
  4. Titrate corticosteroid to a medium dose
  5. Consider Leukotriene Receptor Antagonist OR Oral Theophylline OR LAMA
  6. Titrate to a high dose of corticosteroid
  7. Add oral steroids at the lowest dose possible to achieve good control

Paediatric - Respiratory (12 decks)

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