Asthma

Question 1

what is the presentation of asthma in a child?

Answer 1

cough - dry, exertion, nocturnal
wheeze
SOB at rest - ‘sooking’ in ribs with total body breathing, respiratory difficulty and airway obstruction

Question 2

how is asthma diagnosed in a child?

Answer 2

clinical diagnosis

can confirm diagnosis with a trial of ICS for 2 weeks

Question 3

what is the first line preventer for a 4 year old patient with asthma?

Answer 3

LTRA i.e. Monetlukast

Question 4

what is the first line preventer for an 8 year old patient with asthma?

Answer 4

low dose ICS (800mcg)

Question 5

what is the first line treatment for asthma?

Answer 5

short acting B2 agonist (salbutamol) when required

Question 6

how do you asses a child to determine if they require stronger treatment?

Answer 6

assess asthma control;
SABA use per week? 
Absence from school?
Nocturnal symptoms per week?
Exertional symptoms per week?

Question 7

when would you consider adding a preventer?

Answer 7

use the SABA inhaler > 2 times per week
exertion symptoms > 3 times per week
wake up through the nigh with symptoms > once per week

Question 8

what are the side effects of ICS?

Answer 8

oral thrush

height reduction by 0.5-1cm

Question 9

what are the 3 main characteristics of asthma?

Answer 9

wheeze
variability
responds to treatment

Question 10

what are the differential diagnoses of a child who presents with asthma like symptoms and are < 5 years?

Answer 10

asthma 
congenital 
cystic fibrosis 
foreign body 
bronchitis 
primary ciliary dyskinesia

Question 11

what are the differential diagnoses of a child who presents with asthma like symptoms and are > 5 yrs?

Answer 11

vocal cord dysfunction
dysfunctional breathing
habitual cough
pertusis

Question 12

what is the treatment for a mild acute asthma attack?

Answer 12

salbutamol via neb

salbutamol via neb + prednisolone

Question 13

what is the treatment for a severe asthma attack?

Answer 13

IV salbutamol
IV aminophylline 
neb magnesium sulphate
oxygen 
IV hydrocortisone

Question 14

what is the treatment for a moderate asthma attack?

Answer 14

salbutamol via neb + prednisolone

salbutamol, ipratropium bromide neb + prednisolone

Question 15

what is the aetiology of asthma?

Answer 15

primary epithelium abnormality (in skin, gut or airway) which results in eczema/ asthma
allergy then fuels the asthma

genes
interaction with environment
epigenetic (how genes are expressed)

Question 16

what investigations can be useful in the diagnosis of asthma?

Answer 16

spirometry
exhaled nitric oxide
bronchodilator response
(symptoms still no. 1)