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RESP - 1 > Asthma in Children > Flashcards

Asthma in Children Flashcards

1
Q

If a child doesn’t —– it isn’t asthma.

A

Wheeze.

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2
Q

What are the symptoms of asthma?

A

Panting, chronic wheeze, cough and SoB.

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3
Q

What are examples of triggers in asthma?

A

URTI, exercise, allergen, cold weather etc.

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4
Q

Describe asthma.

A

Chronic condition that is variable and reversible. Responds to asthma medication. No uniform definition. See symptoms.

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5
Q

Define asthma.

A

A condition which causes airflow obstruction which varies over time and with treatment.

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6
Q

What is the MASSIVE definition of asthma.

A

Asthma is a clinical syndrome characterised by increased responsiveness of the tracheobronchial tree to a variety of stimuli. The major symptoms include paroxysms of dyspnoea, wheezing and cough, which may vary from mild and almost undetectable to severe and unremitting. The primary physiological manifestation of this hyper responsiveness is variable airway obstruction. This can take the form of spontaneous fluctuations in the severity of obstruction. Histologically, patients with fatal asthma have evidence of mucosal oedema of the bronchi, infiltration of the bronchial mucosa or submucosa with inflammatory cells, especially with eosinophils, and shedding of epithelium and obstruction of peripheral airways with mucus.

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7
Q

What are the similarities in asthma in children and adults?

A

Symptoms, common, same triggers, same treatment, same pathology.

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8
Q

What are the differences in asthma in children and adults?

A

Gender (more common in boys and women)
Severe asthma tends to burn out
Occupational asthma uncommon

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9
Q

What is the epidemiology of asthma like in the UK?

A

1 million UK children
100,000 in Scotland
5% of UK children on inhaled steroids.
Highest prevalence of asthma in the UK.

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10
Q

Describe the multiple hit theory with asthma.

A

Idea that there are lots of different aetiologies and a combination of these leads to the same common pathway –> asthma.

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11
Q

What are 5 settings where asthma may take place?

A 
Infant onset
Childhood onset
Adult onset
Excertional asthma 
Occupational asthma
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12
Q

Give an example of multiple hits leading to asthma.

A

Genes
Inherently abnormal lungs
Early onset atopy
Later exposures - rhinovirus, exercise, smoking.

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13
Q

What are the many inconsistencies with asthma in children?

A 
Transient vs persistent
Different severities
Different age of onset
Heterogeneity in response
Different triggers
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14
Q

How can people have these inconsistencies but still all have asthma symptoms?

A

Individual factors may vary but if the sum is high enough to reach threshold for symptoms they have asthma. May be transient in that if environment changes it can push them above or below threshold by the way their ‘sum’ works.

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15
Q

What can you do to determine a diagnosis of asthma?

A 
All in the history. 
Examination unhelpful, likely to be wheezing, stethoscope never important. 
No asthma test
Peak flow random number generator
Allergy tests irrelevant
Spirometry lacks specificity
Exhaled NO unproven
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16
Q

Why is peak flow unreliable in children?

A

Peak flow varies so much anyway in children who don’t even have asthma.

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17
Q

How is the sound of wheeze produced in children with asthma?

A

Bronchoconstriction, airway thickening and luminal secretions lead to turbulent flow which gives a wheeze noise.
Children’s airways are smaller and likely to be more musical.

18
Q

Is wheeze often mistaken?

A

> 55% of reported wheeze truly rattle/stretor/stridor.

Aberdeen 75% wheeze in two year olds not genuine - rattle vs whistle is a good dichotomy.

19
Q

What does SoB at rest indicate?

A

Significant resp difficulty - <30% lung function.
Airway obstruction.
Can be seen with looking in of ribs with wheeze.

20
Q

What is to be said about coughing in asthmatic children?

A

Dry
Nocturnal (just after falling asleep)
Exertional

21
Q

What are some triggers for asthma?

A

URTI (rhinovirus in 75%), exercise, allergen, cold air, other - emotion, menstruation.

22
Q

What is atopy?

A

Certain genetic predisposition to inheriting asthma - it doesn’t cause asthma.
Atopy and asthma secondary to same process, URTI primary precipitant.

23
Q

What things might you find out in the history that may point towards asthma?

A

Eczema, hay fever, food allergies, family history.

24
Q

What is also really helpful for diagnosis?

A

Trial of treatment. If it works = asthma!

Asthma treatment = ICS for 2 months.

25
Q

What would the perfect asthma patient have?

A 
Wheeze, SoB at rest
Multitrigger
Sinusoidal 
Atopy
Parental Asthma
Responds to treatment
26
Q

What are other rarer conditions you should exclude before diagnosing asthma?

A 
Foreign body
Cystic fibrosis
Immune deficiency
Ciliary dyskinesia
Tracheo-bronchomalacia
Aspiration, ?? Gastro-oesophageal reflux
27
Q

If the cilia aren’t working what sign do you get?

A

Wet, raspy cough.

28
Q

If the airways are floppy what sign do you get?

A

Wet, rattley cough.

29
Q

Asthma and what are two sides of the same coin?

A

Viral Induced Wheeze.

30
Q

Discuss Asthma vs VIW.

A

Not separate condition - different shades of the same colour. ?should it be treated.

31
Q

Which treatments work and which don’t with infrequent episodic wheeze with a cold?

A

Salbutamol works.

Oral steroids at home/hospital, short burst of LRTA don’t work. ?ICS.

32
Q

When is it not asthma?

A

Under 18 months, most likely infection.
Over 5 yrs - most likely asthma.
But if it sounds like asthma and responds to asthma it is asthma regardless of age.

33
Q

If it’s not asthma, and its an isolated cough, what could it be?

A

Bronchitis (2-3 year old, wet cough)
Pertussis (any age, fits, vomit, haematoma).
Habitual cough (8-12 year old, single loud cough).
Tracheomalacia (life long loud cough).

34
Q

If it’s asthma, but the child is still wheezing what could it possibly be?

A 
Small print - 
CF
Foreign body 
Infectious disease
Patient care device.
35
Q

What is bronchitis?

A

Very common, not described.
Loose rattly cough, noisy breathing. Post-Jussive vomit - ‘glut’.
Child very well, parent v worried.
Chest free of wheeze/creps. Self limiting.

36
Q

What is the mechanism of bacterial bronchitis?

A

Disturbed mucociliary clearance which may have occurred due to infection with RSV/adenovirus/rhinovirus. Haemophilus culture mechanism, 4+ week recovery.
Infection secondary.
Lack of social inhibition.

37
Q

What is the natural history of bacterial bronchitis?

A 
Following URTI. 
Lasts 4 weeis. 
60-80% respond. 
First bad winter, second winter better, third winter fine. 
Caused by pneumococcus/H flu.
38
Q

Do you treat with bacterial bronchitis?

A

Argument over whether to not treat as it is self limiting, or to treat and lower QoL, risk of diarrhoea.

39
Q

What is pertussis?

A

AKA whooping cough. Symptoms similar to cold, but then get horrible coughing fits, high pitched whoop sound as person breaths in after coughing fit. V common. Can cause vomiting, colour change, petechiae.

40
Q

Is there a vaccination for pertussis?

A

Yes, it reduces risk and severity of pertussis.

41
Q

What is Turner’s approach to the preschool cough?

A

Associated wheeze? Wheeze algorithm, if not:
Moist or dry - dry - watchful waiting, moist (pertussis, habit cough, tracheomalacia, previous pneumonia, CF) - responds to antibiotics? Bacterial bronchitis, no –> watchful waiting.

42
Q

What are the important things to remember with asthma in children?

A

No wheeze, no asthma
No asthma test
Confirm diagnosis with trial of ICS
No lower age limit for diagnosing asthma

RESP - 1 (27 decks)

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