Asthma and/or Viral induced wheeze in a child Flashcards
What are the criteria for a life threatening asthma attack (BTS/SIGN)?
- SpO2 <92% (same as severe)
- PEF <33% best or predicted
- Silent chest
- Poor respiratory effort
- Agitation
- Altered consciousness
- Cyanosis
May not be able to complete sentences.
What are the criteria for a severe asthma attack (BTS/SIGN)?
- SpO2 < 92%
- PEF 33-50% best or predicted
- Too breathless to talk or feed
Heart rate
- >125 (>5 years)
- >140 (1-5 years)
Respiratory rate
- >30 breaths/min (>5 years)
- >40 (1-5 years)
- Use of accessory neck muscles
What is the management of asthma in children?
This applies for children <12 years old. Older children are treated as adults.
Define asthma.
Asthma is a chronic respiratory disorder characterised by
- variable airway inflammation,
- airway obstruction,
- and airway hyper-responsiveness.
What is the epidemiology of paediatric asthma?
prevalent in UK, US(8.5%) and Australia
increasing prevalence
higher prevalence in prepubertal males and postpubertal females
What factors are linked to increased prevalence of paediatric asthma?
- Allergic sensitisation/atopic disease
- Exposure to tobacco
- Non-viral induced wheeze*
- Respiratory infections in early childhood - RSV and hRV
- Maternal stress
- Pollution
*in response to emotion, weather, tobacco, exercise
Describe the presenting symptoms of childhood asthma.
- Intermittent wheeze (non-viral triggers)
- Dry cough at night time
- Responsiveness to medication
- SOB on exertion
Wheeze and recurrent cough triggered by viral infections /weather /exercise
What are the findings on examination in paediatric asthma?
- Widespread polyphonic wheeze
- Chest tighness/increased work of breathing - chest recessions/retractions, tachypnoea, accessory muscle usage
- Atopic disease e.g. eczema
- Chest wall deformity - Harrrison’s sulci or hyperinflation (uncommon)
How does spirometry aid in the diagnosis of asthma in children?
Obstructive pattern seen
- Decreased FEV1/FVC ratio - usually <0.90
- Decreased mid-flow - MEF25 % of FVC or FEF25-75 % of FVC
- Decreased FEV1
- Spirometry is usually feasible in children >5years.
How does response to bronchodilator on spirometry aid in the diagnosis of paediatric asthma?
Shows reversibility - >12% improvement in FEV1 is significant and suggestive of asthma
Lack of response usually signifies alternative diagnosis
Can PEFR be used in the diagnosis of paediatric asthma?
No because of low sensitivity and dependance on effort.
What tests (other than spirometry/medication reponse) can aid in the diagnosis of asthma?
- Airway challenge tests - decrease of 15-20% in FEV1 with challenge
- FeNO - fractional expired nitric oxide may be elevated
- Exercise challenge test - decrease in FEV1 >12% or in PEFR >15% is consistet with exercise-induced bronchocontriction. Measured at baseline and every 5min up to 20min. Done in children >6years.
- FBC - eosinophilia >4% assoc. with asthma
- Sputum culture
- Sweat test - chloride >60mmol/L on repeat samples is CF
- Bronchoscopy - exclude aspiration, tracheomalacia, bronchomalacia
- BAL - eosinophilia (>1.2%) or sputum eosinophilia (>3%)
- Electron micrograph ciliary studies - Kartagener’s syndrome
- Skin prick testing - atopy
Give an example of a SABA.
Salbutamol
Give an example of a LABA.
Salmeterol
Give an example of a LRTA.
Leukotriene receptor antagonists are given orally
e.g. montelukast
Which scoring system can be used to assess the severity of acute asthma in children?
PRAM score
Wheeze/asthma care pathway for children >1 years old
