child with wheeze

Question 1

what is a wheeze?

Answer 1

A wheeze is a sound transmitted during expiration in response to intrathoractic airway obstruction.

Question 2

what is the differential diagnosis for wheeze?

Answer 2

asthma, acute viral transient wheeze, and bronchiolitis, pneumonia may foriegn body, food allergy, tracheomalacia, vocal cord dysfunctions, CF, immotile cilia syndrome.

Question 3

does my child have asthma? will he outgrow his asthma?

Answer 3

there is not a single yes or no answer. I do not know. But looking at his past history 1. he has had 4 or more wheezing episodes in the past- one of which has been seen by the doctor for
1 major and 2 minor
1. positive family history of asthma, atopic dermatitis, atopic history
minor- allergic to milk eggs or peanuts, wheezing unrelated to viral illness and serum eosinophil greater than 4%.

Question 4

What history would give you more of a leaning towards foriegn body aspiration?

Answer 4

recurrent pneumonia, recurrent wheeze, or unilateral wheeze.
preform a CT thorax bronchoscope required to retrieve the foreign body.

Question 5

when taking a history associated with wheeze what are you going to ask?

Answer 5

wheeze- sound like? can you feel it?
when is it noticed? breathing in or breathing out?
does anything bring it on?
any food or place that seems to make it worse?
do you take medication for it? does it work?
is there any cough, fever, or increased work of breathing?
past medical: been in hospital or GP for chest infection or wheeze?
do you have any skin conditions? any foods that don’t agree with you? heart condition? tummy problems?
medication? allergies beta blockers? asthma meds - do you have a spacer assess technique.
family history? asthma or history of atopy
developmental: small for age? any brothers or sisters how is she growing in comparison with them?
premature? lung condition?
social? any smokers in the house? is the house damp? how many days of school missed?

Question 6

investigations for wheeze?

Answer 6

FBC- eosinophilia 
CXR- infection
pulmonary function= older than 5 
peak flow - improve greater than 20% suggest bronchial hyper activity 
allergy testing

Question 7

the 6 step approach to management

Answer 7

1. clarify no specific test to diagnosis asthma in young children.
   what type of asthma is it? viral asthma, atopic asthma, exercise related, steriods do not work if acute viral without history of atopic asthma.
2. asthma action plan
3. education: environment, smoking, technique and spacers
4. medication - use and review ddx, compliance, check for other medical conditions, peak flow diary twice a day. exercise- SABA before
5. monitoring asthma control
6. management of bronchiolitis- oxygen, ng tube, hypertonic saline
   follow-up 6 months times

Question 8

medication strategies in asthma

Answer 8

less than 5- mild (less than 2 per week) SABA
regular preventor- inhaled steriods at a low dose 200 micrograms per day) or a leukotriene inhibitor
add on corticosteriods with leukotriene inhaler
greater than 5 SABA plus low dose steroids
add on LABÁ and then increase steroids
or add in leukotriene inhibitor

Question 9

what is the step wise therapy that you can do in asthma care plan?

Answer 9

1. relief inhaler
2. regular inhaled relief therapy= inhaler plus corticosteriod
3. add on therapy - SABA plus high dose preventer
   or low dose steriod with LABA
4. add in laba and up steriod dose 800 add on the weird and wonderful= theophylline or ipratropium
5. daily steriod tablet maintain high dose inhaled steriod
   5