Asthma clinical features in children

Question 1

What are the tests to diagnose asthma in children ?

Answer 1

There are no tests to diagnose asthma in children

Question 2

How is asthma diagnosed in children ?

Answer 2

Symptom based- no wheeze-> no asthma

Tests may help decisions, if:
- quality of life affected, confirmed diagnosis with trial of
ICS
- quality of life not affected

Question 3

What is asthma ?

Answer 3

Panting
Chronic
Wheeze, cough and SOB
Multiple triggers
Variable/ reversible
Responds to treatment

Question 4

What causes asthma ?

Answer 4

Host response to environment
Infection is important
Physiology abnormal before symptoms 
Syndromes
Genes
Primary epithelial abnormality

Question 5

What are some asthma syndromes ?

Answer 5

Infant onset
Childhood onset
Adult onset
Exertional asthma 
Occupational asthma

Question 6

How can genes cause asthma ?

Answer 6

30-80% of causation

10 variants

Question 7

How can primary epithelial abnormalities contribute to asthma ?

Answer 7

Skin- eczema
Airways- asthma
Gut- allergens

Question 8

What is the epidemiology of asthma ?

Answer 8

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

Question 9

When is it asthma in children ?

Answer 9

All in the history
No diagnostic tests in children
Tests can be useful to exclude diagnosis

Question 10

What can show an asthma diagnosis ?

Answer 10

Spirometry- FEV1/FVC - below 70%

BDR- FEV1 >/= 12%

FeNO- ppb>/= 35

Peak flow >/= 20%

Question 11

How can SOB at rest help diagnose asthma ?

Answer 11

Wheeze
<30% lung function
Airway obstruction
‘Sooking’ in of ribs with wheezing

Question 12

What % of people presenting with a cough actually have asthma ?

Answer 12

10%

Question 13

What is the harms of asthma treatment ?

Answer 13

Cost
Hassle
0.5-1cm loss of height
Oral thrush

Question 14

What are the benefits of asthma treatment ?

Answer 14

Helps diagnosis
If symptoms respond
Improves quality of life
Reduced risks of attacks

Question 15

When is it not asthmas ?

Answer 15

All that is chronic and paediatric and respiratory is not asthma
Under 18 months, most likely infection

If it sounds like asthma and responds to treatment it is asthma regardless of age

Question 16

What are the differential diagnosis when onset is under 5 years ?

Answer 16

Congenital
CF
PCD
Bronchitis 
Foreign body

Question 17

What are the differential diagnosis when onset is over or equal to 5 years ?

Answer 17

Dysfunctional breathing
Vocal cord dysfunction
Habitual cough
Pertussis