Asthma Flashcards

1
Q

What is the pathophysiology of asthma?

A
Bronchoconstriction 
Airway inflammation (due to eosinophil infiltration) 
Mucous plugging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common cause of wheeze in children younger than 5?

A

Viral episodic wheeze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is atopic asthma?

A

Recurrent wheezing in between viral infections

Evidence of allergy to one or more inhaled allergens (e.g house dust mite, pollens or pets)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is bronchomalacia?

A

Where the bronchus is floppy and cannot stay open during breathing
Weak cartilage in the walls of the bronchial tubes
It usually affects children <6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How should a wheeze be described to a parent?

A

A whistling in the chest when your child breathes out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can transmitted upper respiratory noises be distinguished from wheeze on examination?

A

If you hold the stethoscope in front of the child’s mouth what you hear will be transmitted upper respiratory noises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are key features that are associated with a high probability of a child having asthma?

A
  • Symptoms worse at night and in the early morning
  • Symptoms that have nonviral triggers
  • Interval symptoms, i.e. symptoms between acute exacerbations
  • Personal or family history of an atopic disease
  • Positive response to asthma therapy.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What should be looked for on examination of a child with ?asthma

A
  1. Evidence of eczema

2. Examination of the nasal mucosa for allergic rhinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What tests may be carried out to aid the diagnosis of atopy?

A

Skin-prick testing for common allergens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can be used in an uncertain diagnosis of asthma/to assess disease severity?
How can peak flow vary throughout the day in asthmatics?

A

PEFR (not as good for management, can be useful for serial measurements e.g 2W diary)
Spirometry

In poorly controlled asthma:
Peak flow worse in the morning than in the evening
AND THE
Peak flow varies from day to day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the usual findings of FEV1/FVC ratio in asthmatics? What reversibility is seen with salbutamol administration?

A

FEV1/FVC < 70% (obstructive)

improvement of 12% or more confirms bronchodilator reversibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the first step in management of asthma in children?

Second step?

A
  1. SABA

2. SABA + paediatric low dose inhaled corticosteroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some examples of inhaled corticosteroids used in children?

A

Budesonide
Beclometasone
Fluticasone
Mometasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is step 3 in the management of asthma in children?

A

SABA + paediatric low-dose ICS + leukotriene receptor antagonist - e.g Montelukast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is step 4 in the management of asthma in children?
Give examples
How does this vary to adults?

A

SABA + paediatric low-dose ICS + long-acting beta agonist (LABA)

LABA = salmeterol or formeterol

In contrast to the adult guidance, NICE recommend stopping the LTRA at this point if it hasn’t helped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In the treatment of moderate acute asthma how may puffs should be given via a spacer and how regularly?

A

Beta2 agonist 2-10 puffs via spacer
Give one puff of beta2 agonist every 30-60 seconds up to 10 puffs according to response.
Consider oral prednisolone

17
Q

What clinical findings are considered to be part of a moderate asthma attack?

A
Able to talk
SpO2 > 92%
PEF > 50% best or predicted
No clinical features of
severe asthma
May be (some) intercostal recession
18
Q

What clinical findings are considered to be part of a severe asthma attack?

A
SpO2 < 92%
PEF 33-50% best or predicted
Can't complete sentences in one breath or too breathless to talk or feed
Heart rate > 125/min (5-12)
Respiratory rate > 30/min
Use of accessory NECK muscles
19
Q

What clinical findings are considered to be part of a life threatening asthma attack?

A
SpO2 < 92%
PEF < 33% best or predicted
Silent chest
Poor respiratory effort
Altered consciousness
Cyanosis
20
Q

When both salbutamol and aminophylline are given what should be monitored?

A
ECG
Blood electrolytes(Aminophylline can cause cardiac arrhythmias, salbutamol can cause hyperkalaemia)
21
Q

DIFFERENT TYPES OF INHALERS AND INHALER TECHNIQUE

22
Q

What are atypical features of asthma which should prompt seeking another diagnosis?

A

Wet cough/Sputum production
Finger clubbing
Growth failure

23
Q

What are some complications of montelukast?

A

Sleep disturbance and nightmares

24
Q

What are some causes of recurrent or persistent childhood wheeze?

A
Viral episodic wheeze 
Asthma
Multiple trigger wheeze 
Cystic fibrosis 
Bronchiolitis OBLITERANS
Chronic aspiration 
Recurrent anaphylaxis
25
What is usually required in the diagnosis of asthma?
In younger children asthma is usually diagnosed from history and examination alone - Parental description of the symptoms and response to treatment is KEY Improvement of FEV1 of 12% or more confirms bronchodilator reversibility and is characteristic of asthma
26
What does SABA stand for? What are some examples? How quickly do they act/last for?
Short acting beta agonist Salbutamol and terbutaline rapid onset of action - maximum effects after 10-15 minutes Effective for 2-4 hours
27
What is it important to monitor in children with asthma, especially if they are on inhaled corticosteroids?
Growth
28
If a child is describe to have complete control of their asthma what do they have/not have?
- Absence of day-time or night-time symptoms - No limit on activities (including exercise) - No need for reliever use - Normal lung function - No exacerbations (need for hospitalisation or oral steroids) IN 6 MONTHS
29
What are some causes of acute breathlessness in the older child?
Asthma Pneumonia or lower respiratory tract infection Foreign body Anaphylaxis Pneumothorax or pleural effusion Metabolic acidosis - DKA, lactic acidosis, inborn error of metabolism
30
What is the management of an acute, severe asthma attack?
1. SABA - either via spacer or nebulised 2. Oral prednisolone or IV hydrocortisone (Consider) 3. Inhaled ipratropium 4. IV B2 agonist (salbutamol) or aminophylline or magnesium
31
What is the management of an acute, life-threatening asthma attack?
1. SABA - nebulised 2. Oral prednisolone or IV hydrocortisone 3. Nebulised ipratropium (Consider) 4. IV B2 agonist (salbutamol) or aminophylline or magnesium
32
When SABA is given nebulised to a child having an acute asthma attack what dose is given?
2.5mg in children <8 | 5mg in children >8
33
How do you continue management of a child with an asthma attack when they are responding to the treatment?
Continue bronchodilators 1-4 hr prn
34
When can you discharge a child who has been in hospital for an acute asthma attack? What steps are involved in discharge?
``` Discharge when stable on 4 hourly treatment PEFR >75% Continue oral pred for 3-7 days AT DISCHARGE: Review medication and inhaler technique Provide personalised asthma action plan Arrange appropriate follow up ``` (For adults so ?if the same for children) GP follow up within 2 working days Respiratory clinic follow up within 4 weeks For severe or worse - consider psychosocial factors
35
What information can be given to patients with regards to their asthma?
Increasing cough, wheeze, breathlessness and difficulty walking, talking and sleeping, or decreasing relief from bronchodilators all indicate poorly controlled asthma
36
How should acute severe asthma be managed with an inhaler
Oxygen via face mask; 10 puffs of beta2 agonist or nebulised salbutamol Oral Pred Beta2 agonist can be repeated every 15 minutes