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Paediatrics > Asthma in Children > Flashcards

Asthma in Children Flashcards

1
Q

What percentage of children have asthma?

A

15-20%

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2
Q

What factors contribute to the development of bronchial inflammation which leads to asthma?

A
  • Genetic predisposition
  • Atopy
  • Environmental triggers
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3
Q

What environmental triggers can cause asthma attacks?

A
  • URTI
  • Allergens - pollen, house dust mite, feathers, fur
  • Smoking
  • Cold air
  • Exercise
  • Emotional upset
  • Chemical irritant
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4
Q

What is the pathophysiology of asthma?

A

Bronchial inflammation

  • Oedema
  • Excessive mucus production
  • Infiltration of white cells (mast cells, eosinophils, neutrophils, lymphocytes)
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5
Q

What can asthma be related to?

A
  • Eczema
  • Hayfever
  • Food allergies
  • Exercise
  • Smoking
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6
Q

How does asthma present in a child?

A
  • Coughing
  • WHEEZE - recurrent
    • Worse at night
    • Obvious Triggers - precipitated by viral infections
    • Responds to treatment
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7
Q

What questions would you ask to assess the severity of asthma on presentation?

A
  • How frequent
  • Triggers
  • Sleep disturbance
  • Severity of interval symptoms
  • How much school have they missed
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8
Q

What are the long term signs of asthma in children?

A
  • Hyperinflation
  • Harrisons sulci - due to early onset of the disease
  • Generalised polyphonic wheeze
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9
Q

What factors can increase the risk of developing asthma?

A
  • Low brithweight
  • Family history
  • Bottle fed
  • Atopy
  • Male
  • Pollution
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10
Q

How would you investigate for asthma in a child?

A
  • History and examination - usually enough
  • Responds to treatment - 10-15% increase in PEFR
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11
Q

What would be a differential diagnosis for a wheezing child?

A
  • ASTHMA
  • Viral induced wheeze
  • Foreign body
  • Cystic fibrosis
  • Immune deficiency
  • Ciliary dyskinesia
  • Tracheo-bronchomalacia
  • Aspiration - GORD
  • Anaphylaxis
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12
Q

How would you go about assessing a childs control of their asthma?

A
  • Short acting beta agonists/week
  • Absence from school/nursery
  • Nocturnal symptoms/week
  • Exertional symptoms/week
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13
Q

How would you initiate a child with suspected asthma on treatment?

A

Monitored initiation of very low dose/low dose of ICS

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14
Q

What drugs would you use as a regular preventer in a child over the age of 5?

A

Very low dose ICS

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15
Q

What drugs would you use asa regular preventer in children under the age of 5?

A

LTRAs

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16
Q

If very low dose ICS were not controlling asthma well in a child over 5, what would you do next?

A

Add on therapy:

  • Add an inhaled LABA
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17
Q

If a child under the age of 5 was on LRTAs but their control was poor, what would you do next?

A

Add very low dose ICS

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18
Q

If there was no response ICS and an additional LABA, what would be your next step?

A

Remove the LABA and increase ICS dose to low dose

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19
Q

If a child who was on very low dose ICS and LABA showed some benefit, but still poor control, what could you change in their management?

A
  • Continue on LABA, and increase ICS dose

OR

  • Consider alternative therapy and maintain current doses - LTRA
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20
Q

What are SABAs?

A

Short acting beta2-agonists

Have an effect over 2-4 hours

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21
Q

Name some SABA medications

A
  • Salbutamol
  • Terbutaline
22
Q

What are LABAs?

A

Long acting Beta-agonists

Action last up to 12 hours

23
Q

What circumstances are SABAs used in?

A
  • Increased symptoms
  • Acute asthma attacks
24
Q

How do beta agonists work?

A

β2 agonists work by mimicking the effect of norepinephrine on β2 receptors. This produces sympathetic effects on tissues containing β2 receptors.

25
Q

Name some LABA drugs

A
  • Salmeterol
  • Formoterol
26
Q

When are LABAs indicated?

A
  • Exercise induced asthma
  • Chronic asthma management
27
Q

What should always be considered as a cause of poorly controlled asthma?

A

Poor inhaler technique

28
Q

What is ipratropium bromide?

A

Antimuscarinic bronchodilator
Muscarinic antagoinists competitively inhibit cholinergic receptors on bronchial smooth muscle

Block action of acetylcholine on the nerve endings therefore inhibiting parasympathetic effect -> dilatation of the airways.

29
Q

How do inhaled corticosteroids work?

A

Reduce inflammation - often known as preventer

30
Q

What are the side effects of inhaled corticosteroids?

A

None at low doses, however at high:

  • Impaired growth
  • Adrenal suppression
  • Altered bone
31
Q

If a child was suffering from exercise induced asthma, how would you manage this?

A

SABA, and if that doesn’t work progress to LABA + ICS

32
Q

What clinical features suggest a child is having an asthma attack?

A
  • Wheeze
  • Tachypnoea
  • Increasing tachycardia
  • Accessory muscle use
  • Inability to speak
33
Q

What would indicate moderate acute asthma?

A
  • O2 saturations >92%
  • Peak flow >50% predicted
  • No clinical features of severe asthma
34
Q

What would indicate severe acute asthma?

A
  • Too breathless to talk/feed
  • Accessory muscle use
  • O2 saturations <92%
  • RR - >30/min (over 5), >50/min (2-5)
  • Pulse - > 130/min (2-5), >120/min (over 5)
  • Peak flow - < 50% (if you can get it)
35
Q

What clinically would indicate life-threatening asthma attack?

A
  • Slient chest
  • Poor respiratory effort
  • Altered consciousness
  • Cyanosis
  • Oxygen saturations <92%
  • Peak flow < 30% predicted
36
Q

How would you assess the severity of an asthma attack in a child?

A
  • Ability to talk
  • Breathing - tachypnoea, recession, wheeze, silent chest
  • Pulse
  • Level of consiousness
  • Cyanosis
  • PEFR
  • O2 saturations
37
Q

How would you treat someone with an acute asthma attack?

A
  • SABA via large volume spacer - 2-4 puffs, increasing by 2 puffs every 2 minutes to 10 puffs
  • Consider Oral prednisolone
38
Q

How would you manage a child with severe asthma attack?

A
  • High flow oxygen - 100% via nasal prongs/face mask
  • SABA - inhaler or nebulised
  • Oral prednisolone/IV hydrocortisone
  • Nebulised ipratropium bromide
39
Q

How would you treat a child with life threatening asthma?

A

Call for HELP!!!! and alert ICU

  • High flow oxygen + Neb. SABA + Neb. Ipra. Bromide
  • IV hydrocortisone
  • IV Amynophilline
  • IV Magnesium sulfate
  • Intubation and ventilation
40
Q

What would you do if a child with severe/life-threatening asthma was not responding to treatment?

A
  • Move to HDU/ITU
  • Consider CXR + Blood gases
  • Intubate and ventilate
41
Q

What should you consider using if IV amynophilline or salbutamol?

A

Monitor potassium shifts

  • ECG
  • U+Es
42
Q

What is the lung deposition of inhaled drug without a spacer?

A

= 5%

43
Q

What percentage of an inhaled drug is deposited in the lung when using in combination with a spacer?

A

= 20%

44
Q

What are LTRAs?

A

Leukotriene Receptor Antagonists

Block the effects of leukotrienes at the LTC4, LTD4 and LTE4 receptors in the airways, decreasing both the early and late responses to inhaled allergens.

45
Q

What are different modes of delivering inhaled drugs?

A
  • pMDI
  • Breat actuated metered dose inhaler
  • Dry Powder inhaler
  • Nebuliser
46
Q

What is the recommended age group for pMDIs?

A
  • 0-2 years - spacer + facemask
  • >2 years - spacer alone
47
Q

What age are breath actuated metered dose inhalers recommended for?

A

6+

48
Q

What is the name of the main LTRA used in asthma?

A

Montelukast

49
Q

What common problems can occur when trying to manage asthma?

A
  • POOR INHALER TECHNIQUE
  • Inadequate perception/planning for attacks
  • Too much inhaled steroid
  • Not recognising nocturnal waking as a sign of dangerous asthma
50
Q

What lifestyle changes can be made to try to improve asthma symptoms?

A
  • Smoking cessation - self and family
  • Removal of environmental triggers
51
Q

What signs would you see on examination in a child with asthma?

A
  • Reduced breathing but hyperinflated chest
  • Use of accessory muscles
  • Chest wall retraction on breathing
  • Hyper-resonant chest
  • Wheeze

Paediatrics (27 decks)

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