Asthma Flashcards
what is the presentation of asthma in a child?
cough - dry, exertion, nocturnal
wheeze
SOB at rest - ‘sooking’ in ribs with total body breathing, respiratory difficulty and airway obstruction
how is asthma diagnosed in a child?
clinical diagnosis
can confirm diagnosis with a trial of ICS for 2 weeks
what is the first line preventer for a 4 year old patient with asthma?
LTRA i.e. Monetlukast
what is the first line preventer for an 8 year old patient with asthma?
low dose ICS (800mcg)
what is the first line treatment for asthma?
short acting B2 agonist (salbutamol) when required
how do you asses a child to determine if they require stronger treatment?
assess asthma control; SABA use per week? Absence from school? Nocturnal symptoms per week? Exertional symptoms per week?
when would you consider adding a preventer?
use the SABA inhaler > 2 times per week
exertion symptoms > 3 times per week
wake up through the nigh with symptoms > once per week
what are the side effects of ICS?
oral thrush
height reduction by 0.5-1cm
what are the 3 main characteristics of asthma?
wheeze
variability
responds to treatment
what are the differential diagnoses of a child who presents with asthma like symptoms and are < 5 years?
asthma congenital cystic fibrosis foreign body bronchitis primary ciliary dyskinesia
what are the differential diagnoses of a child who presents with asthma like symptoms and are > 5 yrs?
vocal cord dysfunction
dysfunctional breathing
habitual cough
pertusis
what is the treatment for a mild acute asthma attack?
salbutamol via neb
salbutamol via neb + prednisolone
what is the treatment for a severe asthma attack?
IV salbutamol IV aminophylline neb magnesium sulphate oxygen IV hydrocortisone
what is the treatment for a moderate asthma attack?
salbutamol via neb + prednisolone
salbutamol, ipratropium bromide neb + prednisolone
what is the aetiology of asthma?
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)
what investigations can be useful in the diagnosis of asthma?
spirometry
exhaled nitric oxide
bronchodilator response
(symptoms still no. 1)