Asthma - Clinical features in Children Flashcards
How is asthma diagnosed?
Symptom based diagnosis
What are the symptoms identical to?
Lower Respiratory Tract Infections (LRTI)
Definite sign of asthma
Wheeze
What is an ICS and when would they be trialed?
Inhaled corticosteroids, trialed if QoL (quality of life) affected
If there is no wheeze…. Will there be asthma?
NO!
What are the symptoms of asthma?
Chronic Wheeze, cough, SOB (Shortness of Breath),
(with multible triggers, is reversiable/variable and responds to asthma treatment.)
Wheeze
Variability
Respond to treatment
Asthma syndromes:
eg infant, child, adult, athlete, occupational (different triggers). Not one dingle cause for asthma.
What causes asthma?
Genes
30-80% of causation
Interact with environment
Epigenetics
How many genetic variations can impact the likelyhood to develop asthma?
~10 variants making modest contribution eg
ADAM33, ORMDL3.
“Genes load the gun the environment pullls the trigger”
How many children have Asthma UK?
1.1 million UK children
5% of UK children on inhaled steroids!
In studies where both parents had asthma, what preventative methods could be used for offspring to avoid developing asthma?
Feeding:
- Breast
- Late weaning
Avoiding Allergens:
- Ante- and post-natal (no pets and no house dust mites)
Avoiding Smoking
What could be another diagnosis for a wheeze/wheezy cough/being chesty/recurrent “chest infections”?
Name some of the inconsistencies in asthma
"Transient" vs persistent VIW (viral induced wheeze) versus asthma/MTW (multi trigger wheeze) Different severities Different age for onset Different effective treatment Different triggers
What 3 years are potentially the most important in terms of development of asthma?
First 3 years! The early environment causes childhood asthma.
What is a NCD?
Non-communicable disease
What affect does pre natal conditions and environment have on us developing asthma?
A lot!
If a child’s quality of life is unaffected by the symptoms, what do you do?
Watch, wait and see what happens
If a child’s quality of life is affected by the symptoms, what do you do?
Trial of inhaled steroids as a diagnostic test
Why is an allergy test not much help in diagnosing asthma?
Most people with an allergy don’t have asthma, and 25% people with asthma don’t have an allergy.
Why is spirometry not very helpful in diagnosis?
If normal can have asthma, if abnormal child might still not have asthma.
What test might be helpful in diagnosing asthma in chil;dren and why?
Exhaled nitric Oxide as a test- tells you how much allergic inflammation in the lungs (Eosinophils produce NO
What ages is the uncertainty the greatest and why?
Under 5’s as tests are even less reliable than normal
Do children get Cough variant asthma?
No, only adults, although children may predominantly cough
If a parent comes in saying that their child has a wheeze, how is best to tell if it is a wheeze or not?
If you ask them to describe the noise as more of a whistle or rattle. as most common 2 noises. More often than not is actually the rattle of bronchitis and not the whistle of asthma.
What differentiates an asthmatic cough?
Asthmatic cough = dry, often nocturnal just after falling asleep and brought on by exercise
How long does it take inhaled steroids to have their maximal effect?
2 months. No response after 2 months, then it doesn’t work.
How do you eliminate “false positive” responses from children trialling brown inhaler for 2 months?
Get them on a “holiday” - take them off the medication and see if their symptoms come back
What are the potential harms from doing a trial of treatment?
Cost
Hassle
Potentially 0.5-1cm height loss
Oral thrush
Under 18 months is it more likely to be infection or asthma?
Over 5 years is it most likely to be infection or asthma?
Under 18 months = infection
Over 5 years = asthma
