Childhood Asthma Flashcards
Asthma refers to a (acute or chronic ?) __________ disorder of the __________. It is a clinical syndrome characterized by episodic (reversible or irreversible?) airway __________, increased __________, and airway __________.
chronic ; inflammatory ; airways
reversible ; obstruction
bronchial reactivity
inflammation.
Asthma
Most-5yrs, 1⁄2-3yrs,transient _________ (20% wheeze in infancy, ____yrs no longer wheezing)
__________+_________-wheeze till teenage years.
wheezers; 6
Early wheezing; allergies
Prepubertal (M>F, M=F, or F>M?)
adolesence (M>F, M=F, or F>M?)
adult onset (M>F, M=F, or F>M?)
M>F
M=F
F>M
Risk Factors for Asthma
__________ of allergic disease
The presence of allergen-specific immunoglobulin __________,
__________ illnesses
exposure to __________(outdoor and indoor),cigarette smoke, fumes. Food, House dust mite etc.
__________, and ? lower socioeconomic status.
Family history
E (IgE),
Viral respiratory ; aeroallergens
Obesity
In asthma, there’s _________,________ and _________ leading to _________________ leading to _______
Bronchoconstriction
Airway inflammation
Mucus production
Increased airway resistance
Gas trapping
Allergic asthma
_______hood; associated with a family history of allergic disease like eczema, ___________ or food allergy.
Sputum – _________ airway inflammation
Respond well to ________ _________ treatment
Childhood
allergic rhinitis
– eosinophilic
inhaled corticosteroid treatment
Non-allergic asthma
Not associated with _________ ;
Sputum- may be _________, _________ or _________
(More or Less?) short-term response to ICS
allergy; neutrophilic
eosinophilic ; paucigranulocytic
Less
Adult-onset asthma
Usually (allergic or non-allergic?) ;
May be ___________ to ICS
Rule out _______________ asthma
non-allergic ; refractive
Occupational
Asthma with obesity
Some obese patients have prominent respiratory symptoms and little __________________
eosinophilic airway inflammation
Asthma with persistent airflow limitation
Seen in _______ asthma
Thought to be due to ___________________
long-standing
airway wall remodelling
Classification
Based on 1) Frequency and severity of symptoms, including nocturnal symptoms
2)Characteristics of acute episodes.
3) Pulmonary function and exacerbations at the onset of disease prior to initiating treatment.
A) Intermittent: ≤1/Classification
Based on 1) Frequency and severity of symptoms, including nocturnal symptoms
2)Characteristics of acute episodes.
3) Pulmonary function and exacerbations at the onset of disease prior to initiating treatment. A) Intermittent: ≤___/wk,<___ nocturnal in a month
B) Persistent:
_______ persistent(>____/wk but <___/day (daytime symptoms),≥____ nocturnal in a month
Moderate persistent-daily Severe persistent-continous,<2 nocturnal in a month
B) Persistent:
Mild persistent(>1/wk but <1/day (daytime
symptoms),≥2 nocturnal in a month
Moderate persistent-_______
Severe persistent-________
1 ; 2
1/wk ; <1/day
≥2
daily ;continous
Differential diagnosis of asthma
List 5
Primary Ciliary Dyskinesia
Allergic Rhinitis
Gastroesophageal Reflux
Bronchiectasis
Bronchiolitis
Aspiration Syndromes
Laboratory Investigations in asthma
Blood tests: ________,________,________ levels
Chest X ray: __________, ↑ ________________
________ skin tests
Full blood count: Eosinophilia, IgE Levels
Hyperinflation; Bronchial markings
Allergic skin tests
Laboratory Investigation
pulmonary function tests
Spirometry:
Obstruction- Forced vital capacity(FVC) is __________ , __________ FEV1, __________ FEF 25-75% of FVC
_________________25-75 is a sensitive indicator of obstruction and may be the only abnormality in a child with mild disease.
Documentation of ___________________________________ is central to the definition of asthma.
Peak flow rate using a peak flow meter(large airway obstruction)- office setting
normal, reduced
Reduced
Forced Expiratory Flow(FEF)
reversibility of airway obstruction after bronchodilator therapy
Plethysomography: ________________ asthma
__________ ____________ test
__________ challenge: >__years
Chronic persistent
Bronchial Provocation
Exercise; 6
Treatment of Asthma
Assessing and Monitoring
-Impairment :Frequency + intensity of symptoms.
-Functional risk : likelihood of asthma exacerbations, adverse effects from medications, and the likelihood of the progression of lung function decline;
Do _______ every ___________ or more frequently for __________ asthma.
spirometry
1-2 years
uncontrolled
Treatment of Asthma
Education
——— Management
Environmental control and ________ strategies.
___________ monitoring and symptom monitoring
Medication use and adherence (eg, correct ______________ and use of other devices).
Self; avoidance
Peak flow
inhaler techniques
Medications
Rapid relief : Short acting Bronchodilators(__________),systemic _____________ , _____________.
Rapid relief : Short acting Bronchodilators(Salbutamol),systemic corticosteroids, ipratomium bromide.
Medications
Control agents: Inhaled corticosteroids(___________, beclomethasone), inhaled ___________ or nedocromil, long-acting bronchodilators (___________), ___________, leukotriene modifiers, and more recent strategies such as the use of anti-immunoglobulin E (IgE) antibodies (___________ ).
•Combination of steroid and bronchodilator eg ___________ (___________ + ___________) is a common medication for control.
fluticasone ; cromolyn
salmeterol ; theophylline
omalizumab
Seretide ; fluticasone+salmeterol
Assessment of severity
Children aged over 2 years
Moderate asthma exacerbation:
Able to ________
SpO2 <____%.
PEFR ≥50% best or predicted.
Heart rate ≤140 beats/minute in children aged 2-5 years; ≤125/minute in children >5 years.
Respiratory rate ≤40 breaths/minute in children aged 2-5 years; ≤30 breaths/minute in children >5 years.
Measurements: SpO2 <92%, PEFR <33% best or predicted.
talk in sentences.
92
Assessment of severity
Children aged over 2 years
Acute severe asthma:
Can’t ___________________ or too ________________
SpO2 <____%.
PEFR 33-50% best or predicted.
Pulse >140 in children aged 2-5 years; >125 in children aged >5 years.
Respiratory rate >40 breaths/minute aged 2-5 years; >30 breaths/minute aged >5 years.
complete sentences in one breath
breathless to talk or feed.
92
Assessment of severity
Children aged over 2 years
Life-threatening asthma - any one of the following in a child with severe asthma:
Clinical signs: _______ chest, __________ , ______ respiratory effort, ———-tension, exhaustion, confusion.
silent
cyanosis ; poor
hypo
Assessment of severity
Infants and toddlers aged under 2 years
The assessment of acute asthma in early childhood can be difficult.
Most infants are audibly ___________ with ________________ but not ___________.
Life-threatening features include ___________, ___________ and poor respiratory effort.
Moderate: SpO2 ≥92%, audible _________ , using ___________ muscles, still feeding.
Severe: SpO2 <92%, __________ , marked ______________ , too breathless to feed.
wheezy ; intercoastal recession ; distressed.
apnoea ; bradycardia
wheezing ; accessory
cyanosis ; respiratory distress
AIMS OF TREATMENT
To relieve _______________ and __________ as quickly as possible.
To plan the prevention of future relapses.
airflow obstruction; hypoxemia
Management of an acute attack
________ with ___________ every ________ in one hour(2.5mg, 5mg)
IV ___________ 50-100mg
Oral ____________ (2mgKg)
Treatment of any underlying infection
Nebulize; salbutamol
20mins; hydrocortisone
Prednisolone
MEDICATIONS: INHALED BRONCHODILATORS
β2 agonists: __________ , __________ (2.5mg-5mg diluted in 0.9% Normal saline).
Nebulize __________ over the first __________ (O2 driven) or intermittently every __________.
Alternatively, use MDI (__________________) with spacer up to _____ puffs as 1st line treatment, unless this had already been given at home or if nebulizer/nebules not immediately available.
salbutamol ; albuterol
continuously ; hour ; intermittently ; 20mins.
metered dose inhaler ; 10 puffs
MEDICATIONS
Glucorticosteroid : oral/IV (equally effective).
Oral ______________ 1-2mg/kg/d (up to 4hrs before effect).(3-5days).
IV ______________ 4mg/kg divided 6hrly, if child unable to take orally. No added benefit of tapering dose of oral.
methylprednisolone
Hydrocortisone
Inhaled glucocorticosteroids- combined with __________ increases bronchodilator effect, compared to __________. Also gives lower relapse rate than _______ alone on discharge. E.g. 2.4mg budesonide dly in four divided doses.
salbutamol
systemic
oral
MEDICATIONS
Anti-cholinergics:
Nebulised __________________ ,125-250μg diluted in 0.9%N/S. Can be mixed with ————— , given together in same nebulizer and given every _________ initially, if response good then wean salbutamol to 1-2hrly and ipratopium to 4-6hrly or discontinue.(Potentiates its bronchodilator effect). Also reduces mucosal oedema and has less side effects than β2 agonists.
Ipratopium bromide ; β2 agonist
20-30 min
MEDICATIONS
Methylxanthines:
Theophylline(______________ ) infusion. Important to check levels, especially if being taken as routine for prevention. (prevent toxicity)
Aminophylline
MEDICATIONS
Magnesium __________ (infusion or nebulized with salbutamol). Single infusion (40mg/kg max 2g over 20mins).
Magnesium sulphate
In light of the highly efficient inhaled bronchodilators and systemic corticosteroids, a ___________________has no place in the routine treatment of children with asthma exacerbations.
theophylline infusion
____________ are CONTRAINDICATED and associated with avoidable asthma deaths.
Sedatives
Transfer patient to ICU for __________ & mechanical ventilation or __________________________ (NIPPV).(Anaesthetist/ ICU specialist).
intubation ; non-invasive positive pressure ventilation(NIPPV).
Status asthmaticus must be distinguished from other causes of acute breathlessness, including:
a variety of infective conditions, e.g. Respiratory syncitial virus-causing ____________.
Foreign body inhalation and other causes of stridor (e.g. _________, croup, tracheitis, vascular ring, tracheomalacia, etc.).
___________ reaction, _________ .
Primary pulmonary hypertension.
bronchiolitis; epiglottitis
Allergic; anaphylaxis
