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Respiratory System > Asthma in Children > Flashcards

Asthma in Children Flashcards

1
Q

How is asthma distinguished from COPD?

A

By its variability

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2
Q

Major symptoms of asthma?

A

Dyspnoea
Wheeze
Cough

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3
Q

Pathology of asthma

A

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

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4
Q

Simalilarites with asthma in adults

A 
Symptoms
It is common 
Same triggers 
Same treatment 
Same Pathology
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5
Q

Differences with asthma in adults

A

M > F in children, but F > M in adulthood
Severe asthma
Occupation asthma uncommon

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6
Q

What are the multiple hits in the aetiology of asthma

A 
Genes
Abnormal lungs (if have gene but normal lungs -> no asthma)
Early onset atopy 
Later exposures:
-Rhinovirus
-Exercise
-Smoking
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7
Q

Cardinal signs of asthma

A

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)

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8
Q

What is the mechanism of a wheeze?

A

Bornchoconstriction, airway wall thickened and luminal secretions all narrow the airway, and children airways are smaller so more likely to be musical

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9
Q

Name 5 triggers

A 
URTI (rhinovirus)
Exercise 
Allergen
Cold air 
Other - emotion, menstruation
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10
Q

When is it most likely not asthma?

A

< 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

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11
Q

What to do if you suspect asthma but uncertain?

A

Asthma treatment of ICS for 2 months and see if it responds

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12
Q

What guideline are available?

A

BTS/SIGN - UK, Australia and EU
GINA - America
NICE - UK

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13
Q

Aims of treatment

A

Minimal symptoms during day and night
Minimal need for reliever medication
No attacks (exacerbations)
No limitation of physical activity

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14
Q

What is the acronym for measuring control of asthma?

A

SANE

S short acting B agonist use per week
A absence school/nursery
N nocturnal symptoms per week
E excertional symptoms per week

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15
Q

What does the A in SANE indicate?

A

Poor quality of life

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16
Q

What does the N in SANE indicate?

A

Poor control of asthma if experiencing nocturnal symptoms more than once a week

17
Q

What does the S in SANE indicate?

A

If require deliver medication (SABA) more than 3 times per week then shows poor control

18
Q

What to do if well controlled?

A

With no charge or reduce

19
Q

What to do if not well controlled?

A 
Check:
Compliance 
Taking treatment correctly
That they have asthma 
Need to increase dose
20
Q

What is the initial step of the step up step down approach?

A

Start on low dose ICS - even severe may respond to minimal treatment

Review after 2 months

21
Q

Contrast in medication with adults

A

Max dose ICS 800mg
No oral B2 tablet
LTRA first line preventer in <5s

22
Q

Step 1 of treatment in children

A

Inhaled SABA - spacer/MDI or DPI

23
Q

Step 2 of treatment in children

A

Use of regular preventer - Start very low dose of ICS (or LTRA in <5s)

24
Q

When to step up to step 2 in treatment?

A

When using inhaled B2 agonists three times a weeks or more (reliever)
Symptomatic three times a week or more
Waking one night a week

25
Q

Step 3 of treatment in children

A

Add on regular preventer - LABA

Additional add on therapies:

  • Increased ics
  • LTRA
26
Q

Benefits of ICS

A

Useful for diagnosis
Very effective
Very safe

27
Q

Side effects of ICS

A

Height suppression

May be:
Oral candidiasis
Adenocortical suppression

28
Q

What are two rules for LABA use?

A

Do not use without ICS!!!

Use as a fixed dose inhaler

29
Q

Two types of delivery systems?

A

MDI/spacer

dry powder device

30
Q

Points about dry powder devices to remember

A

Under 8s cannot use them

Achieve 20% lung deposition

31
Q

Points about spacers to remember

A

20% lung deposition
Shake between puffs
Wash monthly to reduce status
Increases delivery but 100%

32
Q

Non-pharmological management

A

Stop tobacco smoke exposure

Remove environmental triggers (pets)

33
Q

Treatment of mild acute asthma

A

SABA via spacer

SABA via spacer + prednisolone

34
Q

Treatment of moderate acute asthma

A

SABA via nebuliser + prednisolone

SABA + ipratropium via nebuliser + pred

35
Q

Treatment of severe acute asthma

A 
IV salbutamol 
IV aminophylline
IV magnesium 
IV hydrocortisone 
Intubate and ventilate
36
Q

Use of different steroids

A

Chronic/maintenance = inhaled steroids

Acute treatment = oral steroids

37
Q

Signs of acute asthma

A 
RR
Work of breathing 
HR 
O2 saturation 
Ability to complete sentences 
Confusion due to hypoxia 
Air entry

Respiratory System (29 decks)

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