Asthma Clinical Features Flashcards
What is asthma?
- Literally ‘panting’
- Chronic
- Wheeze, Cough, SOB (shortness of breath)
- Multiple triggers
- Variable/reversible
- Responds to asthma rx
What causes asthma?
- Host response is important.
- Infection is important
- Physiology abnormal before symptoms
- It is a syndrome.
- Genetics
- Allergy
What is the epidemiology of asthma?
- 1.1 million UK children
- 110,000 in Scotland
- 5% of UK children on inhaled steroids
How do you know if it is asthma?
Its all in the history, the examination isn’t useful, stethoscope isn’t important because they are unlikely to be wheezing. Tests can be useful.
What is a wheeze?
No wheeze
No asthma
What is the primary physiological manifestation of this hyperresponsiveness?
Variable airway obstruction
What percentage of children are asthmatic?
1 million, 5% of which are on inhaled steroids
What are the 5 aetiology settings?
Infant onset, Childhood onset Adult onset, Excertional asthma, Occupational asthma
Is a stethoscope useful in examination of asthma?
No
Is there a test for asthma?
NO Peak flow random number generator Allergy tests irrelevant Spirometry lacks specificity Exhaled nitric oxide unproven
Does a cough variant of asthma exist in children?
No, Cough predominant asthma not uncommon in adults
What are the mechanics for wheeze?
Bronchoconstriction
Airway wall thickening
Luminal secretion
What is stertor?
Respiratory sound characterized by heavy snoring or gasping
What is stridor?
A harsh vibrating noise when breathing, caused by obstruction of the windpipe or larynx
What can wheeze be confused for?
rattle/stertor/stridor
What is SOB at rest indicative of?
Significant resp difficulty (<30% lung function) Airway obstruction Sooking in of ribs with wheeze
What triggers exist for asthma?
URTI (rhinovirus in 75%) Exercise Allergen Cold air Other (emotion, menstruation)
What are the features of a child which best suggests asthma?
Wheeze SOB at rest Multitriggered Variable Atopy Parental asthma RESPONDS TO TREATMENT
What conditions can asthma be confused for?
Viral induced wheeze Foreign body Cystic fibrosis Immune deficiency Ciliary dyskinesia Tracheo-brochomalacia Aspiration Gastro-oesophageal reflux
If under 18 months what is asthma most likely to be confused for?
Chest infection
If the child has a cough what can it be indicative of?
–Bronchitis (2-3 year old, wet cough)
–Pertussis (any age, fits, vomit, haematoma)
–Habitual cough (8-12 year old, single loud cough)
–Tracheomalacia (life long loud cough
–Small print as per wheeze
How is bronchitis symptoms different to asthma symptoms?
Loose rattly cough, No wheeze/creps, Also self-limiting
How does bacterial bronchitis affect cilia?
Disturbed mucociliary clearance caused by
– RSV/adenovirus/rhinovirus
What are the considerations when deciding treatment for bacterial bronchitis?
Self limiting (without treatment), quality of life and diarrhoea (with treatment)
What is the difference between pertussis and asthma?
Coughing fits, vomiting, color change and petechiae.
