Asthma Flashcards
Most common chronic disease of childhood
Asthma 15%
Suggestive of asthma in children
- Recurrent wheeze/cough that responds to bronchodilator therapy
Confirmation of diagnosis
Good response to bronchodilators, either in symptom control or PEFR
CXR findings
- Hyperinflation due to air trapping
- Collapse due to mucus plugging
Goal of good asthma management
- Reduction in symptoms
- Normal activity
- School attendance
- Growth
When should a MDI with spacer + face mask definitely be used
Younger than 5 years
At what oxygen saturation should children be admitted to hospital
AT LESS THAN 92%
Describe cough in asthma
- Recurrent
- Dry
- Worse at night
- Worse with exercise
Describe wheeze in asthma
- Expiratory
- Triggered by viral
- Responds to bronchodilators
Triggers for shortness of breath
- Exercise
- Cold
- Allergens
- Smoke!!!
Brief pathology overview
Environmental triggers cause broncho-constriction, mucosal oedema, excess mucus in genetically predisposed child Airway narrowing causes wheeze and SOB
Assessing severity
- Mild/Moderate
Walk, speak whole sentences in one breath
>94% oxygen saturation
- Severe
Use of accessory muscles, intercostals, tracheal tug
Unable to complete sentences
Obvious respiratory distress
90-94% saturation
- Life threatening
Reduced consciousness/collapse
Exhaustion
Cyanosis
<90% O2 sats
Poor respiratory effort
Soft/absent breath souds
Suggestive of asthma in children
- Recurrent wheeze/cough that responds to bronchodilator therapy, difficulty breathing, tightness, cough
- Recur
- Worse at night/mornign
- Triggers->exercise, cold, pets
- History of allergies, family history of allergies
- Widespread wheeze on auscultation
- Lung function + with bronchodilator
Confirmation of diagnosis
- Good response to bronchodilators, either in symptom control or PEFR
- FEV1 before and 10-15 after bronchodilator, reversible +>12% for FEV1
Investigations and significance
- PEFR->record in PEF diary to monitor change, beta-2 agonist bronchodilator response, defined as a 12% or greater improvement in either FEV1 or FVC 10 to 15 minutes after inhalation of beta-2 agonist
- CXR->Exclude pneumothorax in severe.
- Avoid ++radiographs
- Allergy test->skin prick most useful. Specific IgE to common inhaled allergens may identify allergens to avoid
Goal of good asthma management
- Reduction in symptoms Normal activity School attendance Growth
Describe cough in asthma
Recurrent Dry Worse at night Worse with exercise
Describe wheeze in asthma
Expiratory Triggered by viral Responds to bronchodilators
Triggers for shortness of breath
Exercise Cold Allergens Smoke
Evidence of poor asthma control (4)
- Poor growth
- Chronic chest deformity
- Miss school
- Frequent exacerbations
Brief pathology overview
Environmental triggers cause broncho-constriction, mucosal oedema, excess mucus in genetically predisposed child Airway narrowing causes wheeze and SOB
Assessing severity
- Mild: -breathless, not distressed -PEFR reduced, still >50% 2. Severe: -too breathless to talk or feed -RR >50 bpm, >130 tachyC -PEFR
History
- Cough and wheeze?
- Worse at night, dry cough
- Triggers- exercise, viral, temperature
- Acute exacerbations, severity, management
- Affect on life, school, activity
- Revleiver use?
- Effectiveness?
- Other atopic symptoms
- Parental smoking
Examination
- In well controlled, may not have signs between exacerbations
- Respiratory distress
- Chest wall deformity->barrel chest, Harrison’s sulcus
- Listen for wheeze
- Features of atopy
- Measure PEFR with hand held meter
- Check height and weight->poorly controlled asthma shunts growth, as will overuse corticosteroids
- Check inhaler technique
Investigations and significance
PEFR->record in PED diary to monitor change. beta-2 agonist bronchodilator response, defined as a 12% or greater improvement in either FEV1 or FVC 10 to 15 minutes after inhalation of beta-2 agonist CXR->Exclude pneumothorax in severe. Avoid ++radiographs Allergy test->skin prick most useful. Specific IgE to common inhaled allergens may identify allergens to avoid