Asthma in Children Flashcards
How is asthma distinguished from COPD?
By its variability
Major symptoms of asthma?
Dyspnoea
Wheeze
Cough
Pathology of asthma
Hyperresponsiveness - histologically, there is mucosal oedema in the bronchi; infiltration of the bronchial mucosa or submucosa with inflammatory cells, especially eosinophils, and shedding of epithelium and obstruction of peripheral airways with mucous
Simalilarites with asthma in adults
Symptoms It is common Same triggers Same treatment Same Pathology
Differences with asthma in adults
M > F in children, but F > M in adulthood
Severe asthma
Occupation asthma uncommon
What are the multiple hits in the aetiology of asthma
Genes Abnormal lungs (if have gene but normal lungs -> no asthma) Early onset atopy Later exposures: -Rhinovirus -Exercise -Smoking
Cardinal signs of asthma
Wheeze - produces a soft expiratory polyphonic sound
SOB at rest - severe obstruction
Dry cough - may be nocturnal or exertional
Parental asthma
Responds to treatment (ICS)
What is the mechanism of a wheeze?
Bornchoconstriction, airway wall thickened and luminal secretions all narrow the airway, and children airways are smaller so more likely to be musical
Name 5 triggers
URTI (rhinovirus) Exercise Allergen Cold air Other - emotion, menstruation
When is it most likely not asthma?
< 18months - usually infection
> 5yrs - most likely asthma
But if it sounds like asthma and responds to asthma treatment then it is asthma regardless of ages
What to do if you suspect asthma but uncertain?
Asthma treatment of ICS for 2 months and see if it responds
What guideline are available?
BTS/SIGN - UK, Australia and EU
GINA - America
NICE - UK
Aims of treatment
Minimal symptoms during day and night
Minimal need for reliever medication
No attacks (exacerbations)
No limitation of physical activity
What is the acronym for measuring control of asthma?
SANE
S short acting B agonist use per week
A absence school/nursery
N nocturnal symptoms per week
E excertional symptoms per week
What does the A in SANE indicate?
Poor quality of life
What does the N in SANE indicate?
Poor control of asthma if experiencing nocturnal symptoms more than once a week
What does the S in SANE indicate?
If require deliver medication (SABA) more than 3 times per week then shows poor control
What to do if well controlled?
With no charge or reduce
What to do if not well controlled?
Check: Compliance Taking treatment correctly That they have asthma Need to increase dose
What is the initial step of the step up step down approach?
Start on low dose ICS - even severe may respond to minimal treatment
Review after 2 months
Contrast in medication with adults
Max dose ICS 800mg
No oral B2 tablet
LTRA first line preventer in <5s
Step 1 of treatment in children
Inhaled SABA - spacer/MDI or DPI
Step 2 of treatment in children
Use of regular preventer - Start very low dose of ICS (or LTRA in <5s)
When to step up to step 2 in treatment?
When using inhaled B2 agonists three times a weeks or more (reliever)
Symptomatic three times a week or more
Waking one night a week
Step 3 of treatment in children
Add on regular preventer - LABA
Additional add on therapies:
- Increased ics
- LTRA
Benefits of ICS
Useful for diagnosis
Very effective
Very safe
Side effects of ICS
Height suppression
May be:
Oral candidiasis
Adenocortical suppression
What are two rules for LABA use?
Do not use without ICS!!!
Use as a fixed dose inhaler
Two types of delivery systems?
MDI/spacer
dry powder device
Points about dry powder devices to remember
Under 8s cannot use them
Achieve 20% lung deposition
Points about spacers to remember
20% lung deposition
Shake between puffs
Wash monthly to reduce status
Increases delivery but 100%
Non-pharmological management
Stop tobacco smoke exposure
Remove environmental triggers (pets)
Treatment of mild acute asthma
SABA via spacer
SABA via spacer + prednisolone
Treatment of moderate acute asthma
SABA via nebuliser + prednisolone
SABA + ipratropium via nebuliser + pred
Treatment of severe acute asthma
IV salbutamol IV aminophylline IV magnesium IV hydrocortisone Intubate and ventilate
Use of different steroids
Chronic/maintenance = inhaled steroids
Acute treatment = oral steroids
Signs of acute asthma
RR Work of breathing HR O2 saturation Ability to complete sentences Confusion due to hypoxia Air entry
