Asthma in children Flashcards
What are the main features of asthma?
Wheeze, cough, SOB
Chronic
Multiple triggers (pets, allergies, exercise etc.)
Variable (nocturnal/morning)
Reversible (with treatment)
Responds to asthma treatment
What is troublesome asthma?
Abnormal behaviour
- attention seeking
- psychological
What questions should you be asking yourself with troublesome asthma?
Do they actually have asthma?
Are the taking their treatment?
Why aren’t they taking their treatment?
What are the causes of asthma?
Host response to environment
Infection
Physiological abnormalities before symptoms
Genes = predisposition
What other diseases is it common to have with asthma?
Allergies
- Hay fever
- eczema
What are the 5 settings for onset of asthma?
Infant onset
Childhood onset
Adult onset
Exertional onset
Occupational onset
Why was asthma epidemic in UK?
Diagnostic enthusiasm
Increasing recognition
increased rise in westernisation
(not proven)
Hygiene - exposed to less germs and microbes in childhood
Diet - change in diet over last few years
Defining features of asthma?
WHEEZE
SOB at rest
Cough - dry, nocturnal, exertional
Parental history
History of eczema, hay fever, food allergies
RESPONDS TO TREATMENT
REVERSIABLE
Defining features of asthma?
WHEEZE
SOB at rest
Cough - dry, nocturnal, exertional
Parental history
History of eczema, hay fever, food allergies
What are some differential diagnosis’s? (for under 5s)
Congenital
CF
PCD
Bronchitis
Foreign body
What are some differential diagnosis’s? (for over 5s)
Dysfunctional breathing
Vocal chord dysfunction
Habitual cough
Pertussis
What does controlled asthma look like? (4)
To have less than 2 relieving treatments a week
Minimal symptoms day/night
No attacks (exacerbations)
No limitations on physical activity
How do you measure control? (SANE)
Short acting beta agonist/week
Absence from school/nursery
No. nocturnal symptoms/week
Exacerbational symptoms/week
What questions do you consider is asthma is not well controlled? (3)
Are they taking their treatment correctly?
Is it really asthma?
Do you need to step up treatment?
What are the types of medication? (6)
Short acting beta agonists
Inhaled corticosteroids (ICS)
Long acting beta agonists*
Leukotriene receptor antagonists*
Theophylline’s*
Oral steroids
- = add ons
What are the adverse effects of treatment?
Height suppression (0.5 - 1cm)
Oral candidiasis (if don’t brush teeth)
Adrenocortical suppression (purple inhaler)
What are the delivery systems of treatment? (3)
MID/Spacer
Dry powder device
Nebulisers
Why use a spacer with MDI, and what else must you do to increase dosage?
With spacer = 4x dose
Shake = 2x dose
Wash = 2x dose
= 16x dose with all 3 (compared to without spacer)
What lung deposition do you get with DPD?
20% lung deposition
Compare nebulisers to MDI/Spacers? (6)
Louder
Slower
No valve mechanism
Breakdown
Less portable
Expensive
What non medical interventions can help with asthma?
Stop smoking and tobacco smoke exposure
Remove environmental triggers
- Pets
- House dust mites (hard to do)
What medications are used in standard acute asthma?
SABA via spacer
SABA via spacer + pred
What medications are used in moderate acute asthma?
SABA via nebuliser + pred
SABA + ipra via nebuliser + pred
What medications are used in severe asthma?
IV salbutamol
IV aminophylline
IV magnesium (neb)
IV hydrocortisone
Intubate and ventilate (only in very sever cases)
How do you chose what (level of) medication to use?
Respiratory rate
Work of breathing
Heart rate
Oxygen saturations
Ability to complete sentences
Air entry
What are some risk factors for asthma? (9)
Genetic predisposition
Atopy (allergy, hay fever, eczema)
Gender/race
Maternal smoking during pregnancy
Recurrent chest infections/Bronchiolitis
Smoking/exposure as a child
Air pollution
Socioeconomic factors
Obesity
What are the indicators to commence ICA?
Using SABA > 2 times a week
Symptomatic > 2 times a week
Waking one night a week or more
Asthma attack in last 2 years
What are the stages of acute asthma attack?
Moderate
Severe
Life threatening
Near fatal
How do you classify a moderate acute asthma attack?
Increasing symptoms
PEF > 50-70% best/predicted
No features of acute sever asthma
How do you classify a severe acute asthma attack? (4)
Any one of:
PEF 33-50% best or predicted
Respiratory rate >25 min
Heart rate >110 min
Inability to complete sentences in one breath
How do you classify a life threatening acute asthma attack? (11)
Any one of:
PEF <33% best/predicted
SpO2 < 92%
PaO2 < 8kPa
Normal PaCO2 (4.6 - 6 kPa)
Altered conscious level
Exhaustion
Arrythmia
Hypotension
Cyanosis
Silent chest
Poor respiratory effort
How do you classify a near fatal acute asthma attack?
Raised PcCO2 and or/requiring mechanical ventilation with raised inflation pressure.
