Asthma Clinical Features In Children Flashcards
What is the number 1 rule in asthma
No wheeze = No asthma!
Name 6 features of asthma
Panting It is chronic not acute Wheeze, cough and SOB Multiple triggers It is variable/reversible Responds to asthma treatment
Name the triggers of asthma
URTI (rhinovirus in 75%) Exercise (football and trampolining) Allergen Cold air Other (Emotion, menstruation)
What are 3 key words associated with asthma
Wheeze
Variability
Respond to treatment
Is asthma a diagnosis of exclusion
No
Name 5 similarities of childhood asthma and adult asthma
Symptoms Common Same triggers Same treatment Same pathology
What is the reticular basement membrane (RBM) in children and adults with asthma
About the same
Name 3 differences between pediatric and adult asthma
Affects more boys in children and women in adults
Severe asthma in children tends to resolve
Occupational asthma in children is uncommon
How many children in the UK are affected with asthma
1 million
How many children in Scotland are affected with asthma
100,000
How much of the UK children affected with asthma take inhaled steriods
5%
Has the prevalence of asthma been increasing or decreasing
Decreasing since 2004
Has the prevalence of wheeze been increasing or decreasing
Decreasing since 1999
Can asthma be caused by a single gene
No it is a disease of multiple hits
Name the type of hits which can cause asthma to develop
Genes
Inherently abnormal lungs
Early onset atopy
Later exposures (e.g. rhinovirus, exercise, smoking)
State the inconsistencies which can occur in asthma
"Transient” vs persistent Different severities Different age at onset Heterogeneity in response Different triggers
Why is asthma able to produce so many inconsistencies
Everyone is affected by the environment, atopy and lung function
The above contributions will add up to cause asthma however every individual’s exposure is different and therefore cause ‘inconsistences’ in asthma
What is the most important aspect of diagnosing asthma in children
History
What is the history of a child with asthma most likely to look like
Cough
Wheeze
Shortness of breath Upper respiratory tract infections
Should a child be examined when trying to diagnose asthma
No as they are unlikely to be wheezing
Why is there no asthma test for children
The peak flow generates random numbers
Allergy tests are irrelevant
Spirometry lacks specificity
Exhaled nitric oxide is unproven
What causes wheeze
Bronchoconstriction, airway wall thickening and luminal secretions
Why does wheezing in children tend to sound more musical
Because they have smaller airways
How much of reported wheeze in children tends to be rattle, stertor or stridor
55%
How much wheeze in children aged 2 is not genuine in Aberdeen
75%
What does shortness of breath at rest indicate
Severe airway obstruction
Can be seen as the ‘snooking’ in of ribs with wheeze
When does a cough indicate asthma in children
When it is dry, nocturnal and exertional
Does atopy ‘cause’ asthma
No
Which two types of history are important in diagnosing asthma
Familiy and personal (eczema, hayfever, food allergies)
What is the treatment for asthma in children
Inhaled corticosteroids for 2 months
What does taking breaks (‘holidays’) from treatment ensure
Ensures that the diagnosis is not a false positive
What are the ideal conditions when making a diagnosis of asthma in a child
Wheeze (with and without URTI)
SOB @ rest
Parental asthma
Responds to treatment
Out of all of the ideal conditions when making a diagnosis of asthma in a child which is the most important and why
Response to treatment as any other illness is unlikely to respond to it if it is not asthma
What is the best way to approach wheeze in a child
Watch and see or the trial of treatment
What should be done if the trial of treatment does not work
Watch and see
What is viral induced wheeze
Another form of asthma
What can be other causes of wheeze
Foreign body (FB causes noise) Cystic fibrosis Immune deficiency Ciliary dyskinesia Aspiration (maybe Gastro-oesophageal reflux) Tracheo-bronchomalacia
What causes noise (wheeze) in cystic fibrosis, immune deficiency and ciliary dyskinesia
Secretions
How many preschoolers tend to have viral induced wheeze
99%
How can viral induced wheeze be treated
Only with salbutamol
Why does salbutamol work on viral induced wheeze
Because it works on all types of wheeze
When is it unlikely that a child has asthma
If they are under 18 months
They most likely have an infection
What could an isolated cough be
Bronchitis in 2-3-year olds with a wet cough
Pertussis at any age including symptoms of fits, vomiting and haematoma
Habitual cough in 8-12-year olds which presents as a single loud cough
Tracheomalacia (a lifelong cough)
What are the clinical features of bacterial bronchitis
Recurrent wet cough
Darth Vader/tractor like sounds
Palpable fremitus (rattling chest)
Follows from an URTI
Describe the progression of bacterial bronchitis
Tends to last about 4 weeks
60-80% of children respond to treatment
First winter is usually bad, second better and by the third they are fine
Name 6 red flags of bacterial bronchitis
If the child is under 6 months or over 4 years Static or losing weight Disruption of the child’s life Associated SOB when not coughing Acute admission Other co-morbidities (neuro/gastro)
Why bacterial bronchitis best left untreated
It is a self limiting condition
Treatment could reduce quality of life and causes a risk of diarrhoea
What is the best treatment for bacterial bronchitis (sounds contradictory doesn’t it)
Honey!
How is vaccination useful in pertussis
It reduces the risk of infection
Reduces the severity of disease
What are the symptoms of pertussis
Coughing fits
Vomiting
Perechiae
Is the pertussis vaccine effective and why
No
Out of 64 children in Oxford with whooping cough, 55 of them had been vaccinated
