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Laura Paediatrics > Asthma > Flashcards

Asthma Flashcards

1
Q

What is the pathophysiology of asthma?

A 
Bronchoconstriction 
Airway inflammation (due to eosinophil infiltration) 
Mucous plugging
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2
Q

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

A

Viral episodic wheeze

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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)

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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

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5
Q

How should a wheeze be described to a parent?

A

A whistling in the chest when your child breathes out

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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

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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.
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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

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9
Q

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

A

Skin-prick testing for common allergens

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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

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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

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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

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13
Q

What are some examples of inhaled corticosteroids used in children?

A

Budesonide
Beclometasone
Fluticasone
Mometasone

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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

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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

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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

A

-

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
Q

What is usually required in the diagnosis of asthma?

A

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
Q

What does SABA stand for?
What are some examples?
How quickly do they act/last for?

A

Short acting beta agonist
Salbutamol and terbutaline
rapid onset of action - maximum effects after 10-15 minutes
Effective for 2-4 hours

27
Q

What is it important to monitor in children with asthma, especially if they are on inhaled corticosteroids?

A

Growth

28
Q

If a child is describe to have complete control of their asthma what do they have/not have?

A
  • 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
Q

What are some causes of acute breathlessness in the older child?

A

Asthma
Pneumonia or lower respiratory tract infection
Foreign body
Anaphylaxis
Pneumothorax or pleural effusion
Metabolic acidosis - DKA, lactic acidosis, inborn error of metabolism

30
Q

What is the management of an acute, severe asthma attack?

A
  1. SABA - either via spacer or nebulised
  2. Oral prednisolone or IV hydrocortisone

(Consider)

  1. Inhaled ipratropium
  2. IV B2 agonist (salbutamol) or aminophylline or magnesium
31
Q

What is the management of an acute, life-threatening asthma attack?

A
  1. SABA - nebulised
  2. Oral prednisolone or IV hydrocortisone
  3. Nebulised ipratropium

(Consider)
4. IV B2 agonist (salbutamol) or aminophylline or magnesium

32
Q

When SABA is given nebulised to a child having an acute asthma attack what dose is given?

A

2.5mg in children <8

5mg in children >8

33
Q

How do you continue management of a child with an asthma attack when they are responding to the treatment?

A

Continue bronchodilators 1-4 hr prn

34
Q

When can you discharge a child who has been in hospital for an acute asthma attack?
What steps are involved in discharge?

A 
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
Q

What information can be given to patients with regards to their asthma?

A

Increasing cough, wheeze, breathlessness and difficulty walking, talking and sleeping, or decreasing relief from bronchodilators all indicate poorly controlled asthma

36
Q

How should acute severe asthma be managed with an inhaler

A

Oxygen via face mask; 10 puffs of beta2 agonist or nebulised salbutamol
Oral Pred
Beta2 agonist can be repeated every 15 minutes

Laura Paediatrics (20 decks)

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