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Respiratory System DO > Asthma Clinical Features In Children > Flashcards

Asthma Clinical Features In Children Flashcards

1
Q

What is the number 1 rule in asthma

A

No wheeze = No asthma!

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2
Q

Name 6 features of asthma

A 
Panting
It is chronic not acute
Wheeze, cough and SOB
Multiple triggers
It is variable/reversible
Responds to asthma treatment
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3
Q

Name the triggers of asthma

A 
URTI (rhinovirus in 75%)
Exercise (football and trampolining)
Allergen
Cold air
Other (Emotion, menstruation)
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4
Q

What are 3 key words associated with asthma

A

Wheeze
Variability
Respond to treatment

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5
Q

Is asthma a diagnosis of exclusion

A

No

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6
Q

Name 5 similarities of childhood asthma and adult asthma

A 
Symptoms
Common
Same triggers
Same treatment
Same pathology
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7
Q

What is the reticular basement membrane (RBM) in children and adults with asthma

A

About the same

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8
Q

Name 3 differences between pediatric and adult asthma

A

Affects more boys in children and women in adults
Severe asthma in children tends to resolve
Occupational asthma in children is uncommon

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9
Q

How many children in the UK are affected with asthma

A

1 million

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10
Q

How many children in Scotland are affected with asthma

A

100,000

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11
Q

How much of the UK children affected with asthma take inhaled steriods

A

5%

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12
Q

Has the prevalence of asthma been increasing or decreasing

A

Decreasing since 2004

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13
Q

Has the prevalence of wheeze been increasing or decreasing

A

Decreasing since 1999

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14
Q

Can asthma be caused by a single gene

A

No it is a disease of multiple hits

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15
Q

Name the type of hits which can cause asthma to develop

A

Genes
Inherently abnormal lungs
Early onset atopy
Later exposures (e.g. rhinovirus, exercise, smoking)

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16
Q

State the inconsistencies which can occur in asthma

A 
"Transient” vs persistent 
Different severities
Different age at onset
Heterogeneity in response
Different triggers
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17
Q

Why is asthma able to produce so many inconsistencies

A

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

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18
Q

What is the most important aspect of diagnosing asthma in children

A

History

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19
Q

What is the history of a child with asthma most likely to look like

A

Cough
Wheeze
Shortness of breath Upper respiratory tract infections

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20
Q

Should a child be examined when trying to diagnose asthma

A

No as they are unlikely to be wheezing

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21
Q

Why is there no asthma test for children

A

The peak flow generates random numbers
Allergy tests are irrelevant
Spirometry lacks specificity
Exhaled nitric oxide is unproven

22
Q

What causes wheeze

A

Bronchoconstriction, airway wall thickening and luminal secretions

23
Q

Why does wheezing in children tend to sound more musical

A

Because they have smaller airways

24
Q

How much of reported wheeze in children tends to be rattle, stertor or stridor

A

55%

25
Q

How much wheeze in children aged 2 is not genuine in Aberdeen

A

75%

26
Q

What does shortness of breath at rest indicate

A

Severe airway obstruction

Can be seen as the ‘snooking’ in of ribs with wheeze

27
Q

When does a cough indicate asthma in children

A

When it is dry, nocturnal and exertional

28
Q

Does atopy ‘cause’ asthma

A

No

29
Q

Which two types of history are important in diagnosing asthma

A

Familiy and personal (eczema, hayfever, food allergies)

30
Q

What is the treatment for asthma in children

A

Inhaled corticosteroids for 2 months

31
Q

What does taking breaks (‘holidays’) from treatment ensure

A

Ensures that the diagnosis is not a false positive

32
Q

What are the ideal conditions when making a diagnosis of asthma in a child

A

Wheeze (with and without URTI)
SOB @ rest
Parental asthma
Responds to treatment

33
Q

Out of all of the ideal conditions when making a diagnosis of asthma in a child which is the most important and why

A

Response to treatment as any other illness is unlikely to respond to it if it is not asthma

34
Q

What is the best way to approach wheeze in a child

A

Watch and see or the trial of treatment

35
Q

What should be done if the trial of treatment does not work

A

Watch and see

36
Q

What is viral induced wheeze

A

Another form of asthma

37
Q

What can be other causes of wheeze

A 
Foreign body (FB causes noise)
Cystic fibrosis
Immune deficiency
Ciliary dyskinesia
Aspiration (maybe Gastro-oesophageal reflux)
Tracheo-bronchomalacia
38
Q

What causes noise (wheeze) in cystic fibrosis, immune deficiency and ciliary dyskinesia

A

Secretions

39
Q

How many preschoolers tend to have viral induced wheeze

A

99%

40
Q

How can viral induced wheeze be treated

A

Only with salbutamol

41
Q

Why does salbutamol work on viral induced wheeze

A

Because it works on all types of wheeze

42
Q

When is it unlikely that a child has asthma

A

If they are under 18 months

They most likely have an infection

43
Q

What could an isolated cough be

A

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)

44
Q

What are the clinical features of bacterial bronchitis

A

Recurrent wet cough
Darth Vader/tractor like sounds
Palpable fremitus (rattling chest)
Follows from an URTI

45
Q

Describe the progression of bacterial bronchitis

A

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

46
Q

Name 6 red flags of bacterial bronchitis

A 
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)
47
Q

Why bacterial bronchitis best left untreated

A

It is a self limiting condition

Treatment could reduce quality of life and causes a risk of diarrhoea

48
Q

What is the best treatment for bacterial bronchitis (sounds contradictory doesn’t it)

A

Honey!

49
Q

How is vaccination useful in pertussis

A

It reduces the risk of infection

Reduces the severity of disease

50
Q

What are the symptoms of pertussis

A

Coughing fits
Vomiting
Perechiae

51
Q

Is the pertussis vaccine effective and why

A

No

Out of 64 children in Oxford with whooping cough, 55 of them had been vaccinated

Respiratory System DO (33 decks)

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