Asthma

Question 1

Describe when and how asthma may initially present?

Answer 1

May initially present with wheeze.

Before 4yo wheeze is very common due to children having small airways which can be easily obstructed by inflammation from illness –> transient early wheeze

The diagnosis of asthma is therefore only given after the age of 4.

The child should suffer from wheeze as well as interval symptoms in between the acutely unwell episodes.

Interval symptoms include a night cough as well as getting wheezy with exercise/cold/allergens.

It is likely there will also be a PMH/FH of atopy.

Question 2

What are the clinical features of severe asthma?

Answer 2

PEF less than 50%
Respiratory distress
Broken speech
Use of oral steroids 
O2 less than 92%

Question 3

What are the clinical features of life threatening asthma?

Answer 3

PEF less than 33%
Silent chest 
Altered consciousness
Decreased RR
Hypotension
O2 less than 92%

Question 4

What is in each of the following inhalers contain?

blue, brown, purple, green, orange, grey

Answer 4

Blue: salbutamol
Brown: beclametasone
Purple: salmeterol + fluticasone (seretide)
Green: salmeterol
Orange: fluticasone (alternative inhaled corticosteroid)
Grey: ipratropium bromide

Question 5

What is the treatment algorithm for acute exacerbation of asthma in children?

Answer 5

Stage 1: Bronchodilators 10 puffs

Stage 2: Salbutamol nebuliser every 20 mins with O2 (ambulance/hospital) (3 doses if not improving step up treatment)

Stage 3: Ipratropium Bromide nebuliser 500micrograms along with salbutamol

Stage 4: Consider oral steroids, prednisolone po or hydrocortisone IV. (Usually avoid in children saved for emergencies)

Stage 5: PICU admission
IV salbutamol
IV aminophylline
IV magnesium sulphate

Question 6

What is the stepped guideline of treatment for non acute asthma?

Answer 6

Stage 1: Salbutamol reliever
Using 3 times a week/unwell 3 times a week

Stage 2:
Inhaled corticosteroid: Beclometasone or Fluticasone 200MCg

Stage 3:
Add LABA + inhaled corticosteroid (not in under 5’s)
Under 5’s add leukotriene receptor antagonist

Stage 4:
Can increase inh steroid dose to 400MCg

Stage 5: 
Increase dose if inh steroid to 800 mcg 
ƒOR
Try leukotriene receptor antagonists
ƒOr 
Trial Theophyllines

Stage 5:
Oral steroids

Question 7

what are the clinical features of moderate asthma?

Answer 7

marked pulsus paradoxus
O2>92%
PEFR>50% predicted or best value
no clinical features of severe