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Paediatrics > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma

A

Chronic type 1 hyper-responsiveness of airway
Leading to inflammation and obstruction
Inflammation - mucous / muscle hypertrophy and contraction
Variable - 20% peak flow
Reversible - bronchodilator
Responds to treatment

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2
Q

What are types of onset of asthma

A 
Infant
Childhood
Adult 
Exertional
Occupational
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3
Q

What causes asthma

A 
Genetics
FH atopic tendency
Atopy - hay fever / eczema / allergy 
Occupation - smoke
LBW
Obesity 
Environment - smoke / pollution
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4
Q

What triggers asthma

A 
Cold air
Exercise
Smoke
Allergen
Virus - URTI
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5
Q

How does asthma present

A 
Wheeze
SOB - trapped
Dry nocturnal exertional cough
Diurnal - typically worse at night 
Tight chest as muscles contract
Worse at night
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6
Q

What are signs of asthma

A 
Hypercapnia
Hypoxia
Cyanosis
Tachycardia
Accessory muscle 
Resp distress
Hyperinflated lungs
Clubbing - chronic hypoxia
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7
Q

When is it NOT asthma

A 
<18 months = VIW
Productive cough 
Stridor (hard inspiratory)
Asymmetrical signs / unilateral 
Dull percussion
Crepitations
No response to RX
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8
Q

How do you Dx asthma

A

No investigation in children

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9
Q

What can you do to aid Dx

A

Trial of ICS

LTRA <5

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10
Q

How do you monitor

A

Peak flow if >5

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11
Q

If child comes into hospital what tests do you do

A

Pulse oximetry
Peak flow if >5
ABG if life threatening but VBG will work
Bloods - FBC, U+E as salbutamol = hypoK, lactate+CRP if think sepsis
CXR if suspect pneumonia / pneumothorax

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12
Q

Why is normal CO2 worrying

A

Hyperventilating so should be low

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13
Q

What are goals of Rx

A

Minimal Sx
Minimal reliever
No attacks
No limitations

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14
Q

How do you measure control

A

SABA / week
Absence from school
Nocturnal Sx / week
Exertional Sx / week

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15
Q

What are general measures

A

Remove trigger

Stop tobacco exposure

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16
Q

What do you do if asthma Dx / suspected

A

SABA as required

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17
Q

When do you step up

A

If SABA
>3 week
Nocturnal
Oral steroid

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18
Q

What do you add

A

8 week trial of Low dose ICS (even if <5 according to NICE)
If Sx resolved but came back after stopped ICS = offer low dose ICS + SABA
If Sx did not resolve consider other Dx
LTRA <5

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19
Q

What do you do if still not controlled

A 
Add LTRA if not controlled after 4-8 weeks 
Stop if one hasn't worked
REFER 
Add LABA to ICS
Increase to medium dose if inadequate 
Add MART
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20
Q

What are additional

A 
REFER 
High dose ICS
Theophylline
Daily steroid
Biologics
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21
Q

If still not responding what should you query / before you add on therapies

A 
Inhaler technique
Dry CI <8 
MDI with spare = gold
Psychological
Compliance
Dx
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22
Q

What are complications

A

Pneumothorax due to increased trapped alveolar pressure

23
Q

What are doses of ICS

A 
Low = 200
High = 400
24
Q

SE of ICS

A

Oral candidiasis
Height and weight
Adrenal insufficiency

25
Q

What is MART

A

Maintenance AND reliever

Combined ICS and LABA

26
Q

What do you do for children 5-16

A

Treat as adult

27
Q

What is important in the Hx of acute asthma attack / wheezy child

A 
Onset 
Trigger 
Any infection that could trigger 
Specific Sx
Any Rx tried
Any admissions to hospital or ITU 
PMH - atopy / infections / asthma / eczema 
DH - inhalers? 
Immunisation
FH
SH - parental smoke 
Birth / vaccination Hx
28
Q

How do you examine

A 
A - speaking
B - distress / sats / RR. /ausculate
C - CRT / BP / HR 
D - consciousness / pupils / temp / BG
E - rash / ENT / abdo
29
Q

What is a moderate attack

A

SpO2 >92

PEF >50

30
Q

What is a severe attack

A 
SpO2 <92
PEF 33-50
No sentences
HR >125
RR >30 
Accessory neck muscle
31
Q

What is lifethreatening

A 
SpO2 <92
PEF <33
Resp acidosis 
Silent chest as airways so small no air 
Cyanosis
Poor resp effort
Normal CO2 
Exhaustion
Hypotension
Confusion
32
Q

What is fatal

A

Raised PaCO2

33
Q

What do you do in mild asthma attack

A

SABA + spacer - 1 puff every 30s up to 10 puffs

+- prednisolone

34
Q

How do you treat moderate asthma attack

A 
SABA via nebuliser + prednisolone 
Add ipatropium bromide (SAMA) 
Oxygen if low sats
Magnesium sulphate
Oral steroids early
35
Q

How do you treat severe asthma

Peak flow <33%
Can’t complete sentence

A 
IV salbutamol 
IV magnesium sulphate 
IV aminophylline with anti-emetic 
IV hydrocortisone
Steroids 
High flow Oxygen 
Intubate and ventilate if exhausted 
Chest drain if pneumothorax
36
Q

How do you give steroid

A 
IN ALL ATTACK
Maintenance = inhaled
Acute = oral 
10mg <5
40mg >5
3 days or until recover
Repeat if vomit
37
Q

What do you need to do if steroid >14 days

A

Taper down

38
Q

When do you discharge

A

Stable 3-4 hours inhaled SABA
PEF >75%
Sats >94%

39
Q

What must you do before

A 
Check inhaler technique
Asthma management plan
Primary care follow up 1 week
Asthma clinic 1 month
Continue oral steroid
40
Q

Ddx cough

A 
Congenital laryngomalacia
CF
Foegin body
Pertussi
Croup 
Pneumonia
TB
Ciliary dyskinesia
Bronchiolitis
Habitual cough
41
Q

Ddx wheeze

A 
VIW
Bronchiolitis / LRTI
Anaphylaxis 
FB - monophonic as only in one area 
GORD
HF
CF
TB
Aspiration
Tracheo-bronchomalacia
Ciliary dyskinesia
42
Q

What causes viral induced wheeze

A

Viral illness
RSV = common
Persistent / recurrent wheeze but well in between attacks

43
Q

What is multi-trigger wheeze

A

If not caused by virus

44
Q

How does it present and what makes it more likely than asthma

A 
Hx viral illness 
Wheeze
Resp distress
Cough
SOB
Cyanosis
If <3 years old, no Hx of atopy and occurs with viral illness
45
Q

What does VIW not have

A

Crackles in chest

NOT LRTI

46
Q

What is RF

A

Atopy
Previous Hx
Passive smoke

47
Q

How do you treat VIW

A

None if mild
SABA (10 puff)
Inhaled steroid -bexamethasone if recurrent

48
Q

When do you give oral pred

A

If admitted

49
Q

What may you consider given if recurrent/ multi-trigger

A

Preventor

ICS or LTRA

50
Q

What should you encourage parents to do

A

Stop smoking

51
Q

SE of SABA

A

Tachy
Tremor
Flushing
Headache

52
Q

Lifestyle advice

A 
Asthma action plan
Vaccination 
Advise on triggers
Weight loss and smoking cessation
Inhaler technique and peak flow
53
Q

WIW

A

More likely develop asthma

Paediatrics (35 decks)

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