Asthma

Question 1

Definition

Answer 1

Chronic inflammatory disorder of the airways. A reversible obstruction of airways in response to various stimuli in hypersensitive/susceptible individuals.

Question 2

Clinical features

Answer 2

Cough: recurrent, dry, worse at night/with exercise, better with bronchodilators
Wheeze (expiratory): often triggered by viral infections, responds to bronchodilators
SOB: exercise limitation, triggers incl cold, exercise, allergens, smoke

Question 3

History

Answer 3

Cough and wheeze: triggers, patterns (day/night)
Exacerbations: number, severity of worst attack
Impact on life: activities, school, sport
Reliever treatment: frequency, efficacy
PMH: atopy
FH: atopy

Question 4

Acute asthma

Answer 4

Acute SOB
Cough, wheeze
Increased respiratory effort
Fear
Triggers

Question 5

Severity: Mild

Answer 5

Breathless but not distressed

PEFR reduced but >50% normal

Question 6

Severity: Severe

Answer 6

Too breathless to talk/feed/complete sentences
SpO2 30 (>5); >40 (2-5)
HR >125 (>5); >140 (2-5)
PEFR 33-50%

Question 7

Severity: Life-threatening

Answer 7

SpO2<33%
Hypotension
Exhaustion
Confusion
Coma
Silent chest
Cyanosis
Poor respiratory effort

Question 8

Management: acute

Answer 8

SABA up to ten puffs (ipratropium bromide if refractory)
Oxygen
Prednisolone

IV salbutamol
Aminophylline

Not antibiotics in childhood

Question 9

Management: chronic >5years

Answer 9

Step 1: SABA prn
Step 2: add inhaled steroids
Step 3: add LABA; consider leukotriene receptor agonist or oral theophylline
Step 4: increased dose of inhaled steroids
Step 5: add oral low dose daily steroids; refer to respiratory paediatrician

Question 10

Management: chronic <5years

Answer 10

Step 1: SABA prn
Step 2: add inhaled steroids
Step 3: add leukotriene receptor agonist (<6m proceed to S4)
Step 4: Refer to respiratory paediatrician

Question 11

Conservative management

Answer 11

Remove exposure to cigarette smoke

Education and management plan for child and carers

Question 12

Aims of chronic asthma management

Answer 12

No daytime symptoms or night time waking due to asthma
No exacerbations
No need for reliever therapy
No limitations on activity
Normal lung function
Minimal side effects of therapy
‘Relieve symptoms and allow normal activity’

Question 13

Pathophysiology

Answer 13

Environmental triggers cause bronchoconstriction, mucosal oedema, excess mucus production and chronic inflammation in a genetically predisposed child
Airway narrowing causes wheeze and SOB