Asthma Clinical Features

Question 1

What is asthma?

Answer 1

• Literally ‘panting’
• Chronic
• Wheeze, Cough, SOB (shortness of breath)
• Multiple triggers
• Variable/reversible
• Responds to asthma rx

Question 2

What causes asthma?

Answer 2

1. Host response is important.
2. Infection is important
3. Physiology abnormal before symptoms
4. It is a syndrome.
5. Genetics
6. Allergy

Question 3

What is the epidemiology of asthma?

Answer 3

• 1.1 million UK children
• 110,000 in Scotland
• 5% of UK children on inhaled steroids

Question 4

How do you know if it is asthma?

Answer 4

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.

Question 5

What is a wheeze?

Question 6

No wheeze

Answer 6

No asthma

Question 7

What is the primary physiological manifestation of this hyperresponsiveness?

Answer 7

Variable airway obstruction

Question 8

What percentage of children are asthmatic?

Answer 8

1 million, 5% of which are on inhaled steroids

Question 9

What are the 5 aetiology settings?

Answer 9

Infant onset, Childhood onset Adult onset, Excertional asthma, Occupational asthma

Question 10

Is a stethoscope useful in examination of asthma?

Answer 10

No

Question 11

Is there a test for asthma?

Answer 11

NO Peak flow random number generator Allergy tests irrelevant Spirometry lacks specificity Exhaled nitric oxide unproven

Question 12

Does a cough variant of asthma exist in children?

Answer 12

No, Cough predominant asthma not uncommon in adults

Question 13

What are the mechanics for wheeze?

Answer 13

Bronchoconstriction
Airway wall thickening
Luminal secretion

Question 14

What is stertor?

Answer 14

Respiratory sound characterized by heavy snoring or gasping

Question 15

What is stridor?

Answer 15

A harsh vibrating noise when breathing, caused by obstruction of the windpipe or larynx

Question 16

What can wheeze be confused for?

Answer 16

rattle/stertor/stridor

Question 17

What is SOB at rest indicative of?

Answer 17

Significant resp difficulty (<30% lung function) Airway obstruction Sooking in of ribs with wheeze

Question 18

What triggers exist for asthma?

Answer 18

URTI (rhinovirus in 75%) 
Exercise 
Allergen 
Cold air 
Other (emotion, menstruation)

Question 19

What are the features of a child which best suggests asthma?

Answer 19

Wheeze SOB at rest Multitriggered Variable Atopy Parental asthma RESPONDS TO TREATMENT

Question 20

What conditions can asthma be confused for?

Answer 20

Viral induced wheeze Foreign body Cystic fibrosis Immune deficiency Ciliary dyskinesia Tracheo-brochomalacia Aspiration Gastro-oesophageal reflux

Question 21

If under 18 months what is asthma most likely to be confused for?

Answer 21

Chest infection

Question 22

If the child has a cough what can it be indicative of?

Answer 22

–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

Question 23

How is bronchitis symptoms different to asthma symptoms?

Answer 23

Loose rattly cough, No wheeze/creps, Also self-limiting

Question 24

How does bacterial bronchitis affect cilia?

Answer 24

Disturbed mucociliary clearance caused by

– RSV/adenovirus/rhinovirus

Question 25

What are the considerations when deciding treatment for bacterial bronchitis?

Answer 25

Self limiting (without treatment), quality of life and diarrhoea (with treatment)

Question 26

What is the difference between pertussis and asthma?

Answer 26

Coughing fits, vomiting, color change and petechiae.