Asthma in children

Question 1

What are the main features of asthma?

Answer 1

Wheeze, cough, SOB
Chronic
Multiple triggers (pets, allergies, exercise etc.)
Variable (nocturnal/morning)
Reversible (with treatment)
Responds to asthma treatment

Question 2

What is troublesome asthma?

Answer 2

Abnormal behaviour
- attention seeking
- psychological

Question 3

What questions should you be asking yourself with troublesome asthma?

Answer 3

Do they actually have asthma?
Are the taking their treatment?
Why aren’t they taking their treatment?

Question 4

What are the causes of asthma?

Answer 4

Host response to environment
Infection
Physiological abnormalities before symptoms
Genes = predisposition

Question 5

What other diseases is it common to have with asthma?

Answer 5

Allergies
- Hay fever
- eczema

Question 6

What are the 5 settings for onset of asthma?

Answer 6

Infant onset
Childhood onset
Adult onset
Exertional onset
Occupational onset

Question 7

Why was asthma epidemic in UK?

Answer 7

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

Question 8

Defining features of asthma?

Answer 8

WHEEZE
SOB at rest
Cough - dry, nocturnal, exertional
Parental history
History of eczema, hay fever, food allergies
RESPONDS TO TREATMENT
REVERSIABLE

Question 9

Defining features of asthma?

Answer 9

WHEEZE

SOB at rest
Cough - dry, nocturnal, exertional
Parental history
History of eczema, hay fever, food allergies

Question 10

What are some differential diagnosis’s? (for under 5s)

Answer 10

Congenital
CF
PCD
Bronchitis
Foreign body

Question 11

What are some differential diagnosis’s? (for over 5s)

Answer 11

Dysfunctional breathing
Vocal chord dysfunction
Habitual cough
Pertussis

Question 12

What does controlled asthma look like? (4)

Answer 12

To have less than 2 relieving treatments a week
Minimal symptoms day/night
No attacks (exacerbations)
No limitations on physical activity

Question 13

How do you measure control? (SANE)

Answer 13

Short acting beta agonist/week
Absence from school/nursery
No. nocturnal symptoms/week
Exacerbational symptoms/week

Question 14

What questions do you consider is asthma is not well controlled? (3)

Answer 14

Are they taking their treatment correctly?
Is it really asthma?
Do you need to step up treatment?

Question 15

What are the types of medication? (6)

Answer 15

Short acting beta agonists
Inhaled corticosteroids (ICS)
Long acting beta agonists*
Leukotriene receptor antagonists*
Theophylline’s*
Oral steroids

• = add ons

Question 16

What are the adverse effects of treatment?

Answer 16

Height suppression (0.5 - 1cm)
Oral candidiasis (if don’t brush teeth)
Adrenocortical suppression (purple inhaler)

Question 17

What are the delivery systems of treatment? (3)

Answer 17

MID/Spacer
Dry powder device
Nebulisers

Question 18

Why use a spacer with MDI, and what else must you do to increase dosage?

Answer 18

With spacer = 4x dose
Shake = 2x dose
Wash = 2x dose

= 16x dose with all 3 (compared to without spacer)

Question 19

What lung deposition do you get with DPD?

Answer 19

20% lung deposition

Question 20

Compare nebulisers to MDI/Spacers? (6)

Answer 20

Louder
Slower
No valve mechanism
Breakdown
Less portable
Expensive

Question 21

What non medical interventions can help with asthma?

Answer 21

Stop smoking and tobacco smoke exposure
Remove environmental triggers
- Pets
- House dust mites (hard to do)

Question 22

What medications are used in standard acute asthma?

Answer 22

SABA via spacer
SABA via spacer + pred

Question 23

What medications are used in moderate acute asthma?

Answer 23

SABA via nebuliser + pred
SABA + ipra via nebuliser + pred

Question 24

What medications are used in severe asthma?

Answer 24

IV salbutamol
IV aminophylline
IV magnesium (neb)
IV hydrocortisone
Intubate and ventilate (only in very sever cases)

Question 25

How do you chose what (level of) medication to use?

Answer 25

Respiratory rate
Work of breathing
Heart rate
Oxygen saturations
Ability to complete sentences
Air entry

Question 26

What are some risk factors for asthma? (9)

Answer 26

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

Question 27

What are the indicators to commence ICA?

Answer 27

Using SABA > 2 times a week
Symptomatic > 2 times a week
Waking one night a week or more
Asthma attack in last 2 years

Question 28

What are the stages of acute asthma attack?

Answer 28

Moderate
Severe
Life threatening
Near fatal

Question 29

How do you classify a moderate acute asthma attack?

Answer 29

Increasing symptoms
PEF > 50-70% best/predicted
No features of acute sever asthma

Question 30

How do you classify a severe acute asthma attack? (4)

Answer 30

Any one of:
PEF 33-50% best or predicted
Respiratory rate >25 min
Heart rate >110 min
Inability to complete sentences in one breath

Question 31

How do you classify a life threatening acute asthma attack? (11)

Answer 31

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

Question 32

How do you classify a near fatal acute asthma attack?

Answer 32

Raised PcCO2 and or/requiring mechanical ventilation with raised inflation pressure.