Asthma & Acute Asthma (children & Adults) (pathology) Flashcards
What is asthma in children?
Chronic obstructive condition
Variable/reversible with time/treatment
Differential diagnosis of asthma in children under 5 (5)
- CF
- Primary ciliary dyskinesia
- Bronchitis
- Foreign body
- Under 18 months= infection
Differential diagnosis of asthma in children over 5 (4)
- Dysfunctional breathing
- Vocal cord dysfunction
- Habitual cough
- Pertussis (whopping cough)- cough but no wheeze
Risk factors/causes of asthma in children (6)
- Genes
- Environment
- Epigenetics
- Primary epithelial abnormality -> eczema/asthma/allergy
- Allergy fuels asthma but does NOT cause it
- Parental asthma (esp. mother)
Signs/symptoms of asthma in children (3)
- Wheeze
- Dry Cough (before bed + exertional)
- SOB
Triggers of asthma in children (9)
- Exercise
- Cold air
- Cigarette smoke
- Perfumes/strong scents
- URTI’s
- Pets
- Tree/grass pollen
- Food
- Drugs (NSAIDs (nonsteroidal anti-inflammatory drugs)/aspirin)
Asthma in children investigations
- asthma symptoms+ effect on QoL—> trial of ICS for 2 months + easter holiday break for false +ve
- asthma symptoms but NO impact on QoL—> watchful waiting
What may diagnostic tests on children with suspected asthma be useful for?
Diagnostic test not useful in children except —> tests useful for excluding diagnosis
- spirometry
- Bronchodilator reversibility
- FeNO
- Peak flow
What is the management of asthma in children with viral induce wheeze? What are the aims? What is controlled?
bronchodilators + steroids
Aims
- Minimal symptoms+ need for reliver
- No attacks
- No limit to exercise
Control (SANE)
- Short acting beta agonists/week
- Absence school
- Nocturnal symptoms/week
- Exertional symptoms/week
What is the management of non-acute asthma in children (>5 years old)? What is changed if <5 years old)
move up if SABA> 3x week
- Low dose ICS (brown inhaler)
- Add on preventer LABA (blue inhaler)- fixed dose inhaler
- 1 No response to LABA= remove LABA ↑ICS
- 2 Benefit from LABA= ↑ ICS
- 3 Trail of LTRA
- 1 ↑↑ICS + Theophylline
- 2 Oral steroids
< 5 years old
- First line prevention LTRA- MONTELUKAST
3&4 same as >5
What are the side effects of inhaled corticosteroids (ICS) in children?
- height suppression
- oral thrush
What is used to deliver asthma medication in children? How is this cared for?
spacer
wash monthly to ↓static and ↑delivery
Shake inhaler between puffs
What devices should girls 8-11 use to treat non-acute asthma?
Dry powder devices
Symptoms & signs of acute asthma in children(7)
RR Work of breathing HR PO2 Confusion Can they talk? Air entry
Management of mild acute asthma in children
ABA via spacer
SABA spacer+ ORAL prednisolone
Management of moderate asthma in children
SABA via neb +pred
SABA+ SAMA (ipratropium bromide) via neb+ pred
Management of severe asthma in children
IV salbutamol IV aminophylline IV magnesium (neb) IV hydrocortisone Intubate and ventilate
What is asthma in adults?
Type I hypersensitivity
Increased responsiveness of trachea & bronchi to various stimuli and widespread narrowing of airways that changes in severity spontaneously or because of therapy
What are the 2 types of asthma in adults?
1) Widespread narrowing of airways
2) ↑ airway reactivity+ trigger factor-> oedema, bronchoconstriction & ↑mucus=↑narrowing
Differential diagnosis for asthma in adults
Generalised fixed airflow obstruction (AFO) - COPD (irreversible AFO) - Bronchiectasis - CF Localised AFO- stridor - tumour - foreign body
Cardiac (LVF, valvular heart disease)
Risk factors/causes of asthma in adults (7)
- Hereditary
- Atopy (mother> father)
- Smoking exposure
- Epigenetics
- Occupation (bakers, painters, shellfish workers)
- Childhood asthma, bronchitis, wheeze
- Eczema/hay fever
Symptoms and signs of asthma in adults (9)
- Diurnal variation (worse at beginning or end of day)
- Weekly variation (better @ weekends/holidays)
- Annual variation (environmental allergens)
- Wheezing on expiration
- SOB
- Cough – paroxysmal, dry
- Chest tightness
- Sputum- occasional
- Triggers
What to look for in structured clinical assessment of adult asthma (6)?
- Recurrent episodes of symptoms
- Symptom variability
- Absence of symptoms for alternative diagnosis
- Recorded observation of wheeze
- History of atopy
- Record of variable PEF/FEV1
Investigations of adult asthma in spirometry is obstructed
- Full pulmonary function test – exclude COPD
- Carbon monoxide gas transfer = normal because no tissue destruction unlike COPD
- reversibility w/ beta 2 agonist -> FEV1> 12% baseline
- reversibility to oral steroids (Prednisolone for 2 weeks) + peak flow+ baseline & 2-week spirometry
