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Respiratory System > Asthma & Acute Asthma (children & Adults) (pathology) > Flashcards

Asthma & Acute Asthma (children & Adults) (pathology) Flashcards

1
Q

What is asthma in children?

A

Chronic obstructive condition

Variable/reversible with time/treatment

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2
Q

Differential diagnosis of asthma in children under 5 (5)

A
  • CF
  • Primary ciliary dyskinesia
  • Bronchitis
  • Foreign body
  • Under 18 months= infection
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3
Q

Differential diagnosis of asthma in children over 5 (4)

A
  • Dysfunctional breathing
  • Vocal cord dysfunction
  • Habitual cough
  • Pertussis (whopping cough)- cough but no wheeze
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4
Q

Risk factors/causes of asthma in children (6)

A
  • Genes
  • Environment
  • Epigenetics
  • Primary epithelial abnormality -> eczema/asthma/allergy
  • Allergy fuels asthma but does NOT cause it
  • Parental asthma (esp. mother)
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5
Q

Signs/symptoms of asthma in children (3)

A
  • Wheeze
  • Dry Cough (before bed + exertional)
  • SOB
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6
Q

Triggers of asthma in children (9)

A
  • Exercise
  • Cold air
  • Cigarette smoke
  • Perfumes/strong scents
  • URTI’s
  • Pets
  • Tree/grass pollen
  • Food
  • Drugs (NSAIDs (nonsteroidal anti-inflammatory drugs)/aspirin)
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7
Q

Asthma in children investigations

A
  • 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
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8
Q

What may diagnostic tests on children with suspected asthma be useful for?

A

Diagnostic test not useful in children except —> tests useful for excluding diagnosis

  1. spirometry
  2. Bronchodilator reversibility
  3. FeNO
  4. Peak flow
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9
Q

What is the management of asthma in children with viral induce wheeze? What are the aims? What is controlled?

A

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
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10
Q

What is the management of non-acute asthma in children (>5 years old)? What is changed if <5 years old)

A

move up if SABA> 3x week

  1. Low dose ICS (brown inhaler)
  2. Add on preventer LABA (blue inhaler)- fixed dose inhaler
  3. 1 No response to LABA= remove LABA ↑ICS
  4. 2 Benefit from LABA= ↑ ICS
  5. 3 Trail of LTRA
  6. 1 ↑↑ICS + Theophylline
  7. 2 Oral steroids

< 5 years old
- First line prevention LTRA- MONTELUKAST
3&4 same as >5

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11
Q

What are the side effects of inhaled corticosteroids (ICS) in children?

A
  • height suppression

- oral thrush

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12
Q

What is used to deliver asthma medication in children? How is this cared for?

A

spacer

wash monthly to ↓static and ↑delivery
Shake inhaler between puffs

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13
Q

What devices should girls 8-11 use to treat non-acute asthma?

A

Dry powder devices

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14
Q

Symptoms & signs of acute asthma in children(7)

A 
RR 
Work of breathing 
HR
PO2 
Confusion 
Can they talk? 
Air entry
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15
Q

Management of mild acute asthma in children

A

ABA via spacer

SABA spacer+ ORAL prednisolone

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16
Q

Management of moderate asthma in children

A

SABA via neb +pred

SABA+ SAMA (ipratropium bromide) via neb+ pred

17
Q

Management of severe asthma in children

A 
IV salbutamol 
IV aminophylline 
IV magnesium (neb) 
IV hydrocortisone 
Intubate and ventilate
18
Q

What is asthma in adults?

A

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

19
Q

What are the 2 types of asthma in adults?

A

1) Widespread narrowing of airways

2) ↑ airway reactivity+ trigger factor-> oedema, bronchoconstriction & ↑mucus=↑narrowing

20
Q

Differential diagnosis for asthma in adults

A 
Generalised fixed airflow obstruction (AFO)
-	COPD (irreversible AFO)
-	Bronchiectasis 
-	CF
Localised AFO- stridor 
- 	tumour 
- 	foreign body

Cardiac (LVF, valvular heart disease)

21
Q

Risk factors/causes of asthma in adults (7)

A
  • Hereditary
  • Atopy (mother> father)
  • Smoking exposure
  • Epigenetics
  • Occupation (bakers, painters, shellfish workers)
  • Childhood asthma, bronchitis, wheeze
  • Eczema/hay fever
22
Q

Symptoms and signs of asthma in adults (9)

A
  • 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
23
Q

What to look for in structured clinical assessment of adult asthma (6)?

A
  • Recurrent episodes of symptoms
  • Symptom variability
  • Absence of symptoms for alternative diagnosis
  • Recorded observation of wheeze
  • History of atopy
  • Record of variable PEF/FEV1
24
Q

Investigations of adult asthma in spirometry is obstructed

A
  1. Full pulmonary function test – exclude COPD
  2. Carbon monoxide gas transfer = normal because no tissue destruction unlike COPD
  3. reversibility w/ beta 2 agonist -> FEV1> 12% baseline
  4. reversibility to oral steroids (Prednisolone for 2 weeks) + peak flow+ baseline & 2-week spirometry
25
Q

Investigations of adult asthma in spirometry is normal

A
  1. peak flow (2x/day- best of 3 measurements- for 2 weeks)

2. specialist investigations (airway responsiveness to methacholine, histamine and FeNO)

26
Q

Further investigations for adult asthma

A

CXR – to discern form other pathologies
Skin prick test+ tot and specific IgE-> atopic status
FBC- eosinophilia

27
Q

Aims of treatment of adult asthma

A
  • no daytime/night time symptoms
  • no need for rescue medication
  • no asthma attacks
  • no exercise limitation + normal lung function
  • minimal side effects
28
Q

Non-pharmacological treatment of adult asthma

A
  • Exercise
  • Patient education
  • Smoking cessation
  • Weight management
  • Flu/pneumococcal vaccine
29
Q

Pharmacological treatment of adult asthma

A
  1. Low dose ICS (preventer)+ SABA- reliever
  2. Add LABA if SABA> 3x/week
  3. 1 no response to LABA=stop LABA+ ↑ICS
  4. 2 benefit from LABA + ↑ICS
  5. 3 LABA+ ↑ICS+ LTRA, theophylline, LAMA
  6. Refer
30
Q

What is a common side effect of salbutamol?

A

increased heart rate, tremor

31
Q

What are the symptoms and signs of moderate acute adult asthma (6)?

A
  • able to speak
  • HR<100
  • RR< 25
  • PEF 50-75% predicted or best
  • SaO2≥ 92%
  • PaO2≥ 8kPa
32
Q

What is the management of moderate acute adult asthma

A

Management

  • ↑inhaler use
  • Oral steroid
  • Treat trigger (infection)
  • Monitor 12/24 h
  • Back-up plan
33
Q

What are the symptoms and signs of severe acute adult asthma (6)?

A

any of:

  • Inability to complete sentences in 1 breath
  • HR≥110
  • RR≥25
  • PEF 33-50% predicted/best
  • SaO2≥ 92%
  • PaO2≥ 8kPa
34
Q

What is the management of severe acute adult asthma?

A
  • Neb SABA/SAMA
  • Oral/IV steroid
  • Magnesium
  • Aminophylline
  • Level 2/3 care (HDU,ICU)
35
Q

What are the life threatening signs of acute adult asthma (10)?

A

Any of:

  • Grunting
  • Confusion, exhaustion
  • Bradycardia/arrhythmia/hypotension
  • PEF<33% predicted/best
  • Cyanosis
  • Silent chest
  • Poor respiratory effort
  • SaO2<92%
  • PaO2< 8kPa
  • PCO2 normal or ↓ (hyperventilation)
36
Q

What is the sign that acute adult asthma is near fatal?

A

↑PaCO2

Respiratory System (33 decks)

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