Asthma in children Flashcards
three main symptoms of asthma
wheeze
cough
SOB
Asthma definition
condition which causes airflow obstruction which caries over time and with treatment
Similarities with adult and child asthma
symptoms common same triggers same treatment same pathology
Children in the UK with asthma is
1 million
100,000 in Scotland
Multiple aetiology such as
genes
inherently abnormal lungs
early onset atopy
late exposure (rhinovirus, exercise, smoking)
How to examine for asthma?
ALL IN THE HISTORY
Examination is unhelpful! (stethoscope never important, probably not wheezing at the time)
No asthma tests in children
No wheeze
no asthma
SOB at rest
<30% lung function
Common URTI associated with child asthma
rhinovirus
75% of children with asthma
Ideally - in diagnosing asthma a child would have..
wheeze (with and without URTI)
SOB at rest
Parental Asthma
RESPONDS TO TREATMENT
When is it not asthma?
under 18 months (usually infection)
BUT if it sounds like asthma and responds it IS ASTHMA regardless of age
Clinical feature of bacterial bronchitis
recurrent wet cough
Darth vader
very well child
first born
Pertussis
whooping cough
very common
Vaccine reduces risk
Proven risk factors for asthma
Inherited tendency to TgE response to allergens
Asthma, eczema, hay fever, food allergy
Immune response genes
IL-4
IL-5
IgE
Airway Genes
ADAM33
Use of corticosteroid separates asthma from
COPD
Useful investigation
CXR (hyper inflated, hyper lucent)
Skin prick testing (atopic status)
Total and specific IgE
FBC (eosinophilia - level of eosinophils to measure allergy)
Asthma is shown by reversibility to
bronchodilator and corticosteroids
S
A
N
E
How to measure the control of the asthma
short acting beta agonist
absence (from school/nursery)
nocturnal symptoms
exertion symptoms
in general- managing asthma - you always give the patient…
then review after 2 months to monitor progress
low dose inhaled corticosteroids
Classes of medications to treat asthma
short acting beta agonists (SABA)
inhaled corticosteroids (ICS)
long acting beta agonist (LABA)
leukotriene receptor antagonists (LTRA)
theophyllines
oral steroids
Step one in managing asthma would be to give a
short acting beta agonist
SABA
Step two in managing asthma may be to give a
inhaled B2 agonist three times a week
with very low dose ICS
Step three in managing asthma may be to add on a preventer
add a LABA
add an LTRA
increase ICS dose
LABA cannot be used without
ICS
LABA is used as a fixedD
Dose inhaler
Chronic maintenance treatment you would use
inhaled steroids
acute treatment you would use
oral steroids
asthma treatments given to children by
inhaler spacer
nebuliser
dry powder
