Asthma Flashcards
Asthma affects approximately 10-20% of Canadian children
10-20%
Asthma definition
Characterized by paroxysmal or persistent symptoms of Dyspnea chest tightness Wheezing sputum production cough
Associated with
Variable airflow limitation
airway hyperresponsiveness to endogenous & exogenous stimuli
Inflammation and its resultant effects on airway structure
Asthma diagnosis in children <6 years of age is dependent on:
history and physical examination
lung function testing + assessment of airway inflammation are Not feasible, not commonly available
Asthma DDx in infants under 2 yrs (1) and toddler/preschool (1)
Under 2yrs: Bronchiolitis
Dx On the basis of clinical picture
Less than 3 episodes of wheezing
Toddler/preschool: Intermittent virally-induced asthma
Wheezing only during respiratory infections
No asthma symptom between episodes
Do all kids who wheeze have asthma?
No, but Wheezing after age of 5 more likely asthma
in children < 5 years Episodic wheezing and cough also common; The younger the child, the greater the likelihood of an alternative diagnosis explaining recurrent wheeze
Eg. 16 year old girl, Early morning wet cough for years,
In emergency with cough and dyspnea - Asthma?
Bronchiectasis: Chronic infection, Chronic inflammation
Diffuse: Immune deficiency, CF, Primary ciliary dyskinesia
Local: Obstructive foreign body
Red flags in asthma (6)
Symptoms before 6 months of age
No benefit from medications
Acute onset with no previous history
Stridor
Asymmetric sounds and imaging
Constitutional Symptoms: Low weight, Digital Clubbing
PFT findings to Dx asthma
FEV1 post-bronchodilator: >12%
FEV1 < 85%
Methacholine challenge (PC20 < 8 mg/ml) (PC20=provocative conc that causes a rx)
Asthma control criteria (8)
Daytime Sx < 4 days/wk Nighttime Sx < 1 night/wk Phys activity: Normal Exacerbations: Mild, infrequent Absent from work/school: None Need for B2 agonist =90% of personal best PEF diurnal var'n <10-15%
Asthma Tx
Mild: Education, fast-acting bronchodilator, low-dose inhaled corticosteroids (ICS)
No chronic Beta agonists, long or short acting without Inhaled corticosteroid
Moderate and above: Low-dose ICS not enough? Step-up Therapy Options:
Option 1: Add Leukotriene Receptor Antagonist (LTRA)
Option 2: Add Long Acting Beta 2 Agonist (LABA)
Option 3: Increase to medium dose ICS
Verify with asthma pt at each visit: (8)
asthma control Compliance technique and appropriateness of the device used patient’s environment patient’s concerns concomitant disease patient’s PFTs Remember to try to step down
DDx wheezing in child (13)
1. Cardiovascular and pulmonary vascular diseases 2. Tracheobronchialmalacia 3. Airway obstruction (laryngeal, tracheal) 4. Foreign body 5. Aspiration 6. Interstitial lung diseases – hypersensitivity pneumonitis, bronchiolitis obliterans 7. Cystic fibrosis 8. Immotile cilia syndrome 9. Immunodeficiency 10. Recurrent bronchiolitis or other lung infections 11. Allergic bronchopulmonary syndromes (ABPA, etc.) 12. Occupational lung diseases 13. Psychiatric/ psychologic: vocal cord dysfunction; Tourette’s syndrome (vs. cough- equivalent asthma)
