childhood Asthma Flashcards
childhood Asthma
Commonest reason for childhood admissions to hospital in this country.
Children still die from asthma.
Classic features: cough, wheeze, breathlessness.
These + difficulty in walking, talking & breathlessness = worsening asthma
Decreasing relief from bronchodilators = worsening asthma
information on asthma
Asthma is a common cause of breathlessness. It causes coughing and wheezing. Asthma is caused by hyper-reactive airways. The bronchi constrict and secrete mucus. The narrowed airways produce the sound we know as wheezing. This is a high pitched sound heard on expiration. The expiration phase tends to be prolonged in asthmatics. Around 10% of children in the UK have a tendency to asthma. In babies and toddlers, a virus such as a cold can often bring on a few days of wheeziness. This does not necessarily mean they will go on to have asthma through childhood. As children get older, other things can set off the wheezing. These include cigarette smoke, exercise, excitement, dust, pollen, and allergies to animals. In young people with an exacerbation of asthma, it is unusual for bacterial infection to be present, so antibiotics are not usually needed. Children can easily learn to use a spacer device, and can have several puffs of a beta agonist inhaler such as salbutamol, several times a day this is probably as good as a nebuliser in most cases. Small children are better with a face mask attached to the spacer so they don’t have to cooperate with putting their mouth around the mouth piece, as in this clip. Under the age of one, children do not have typical asthma, and beta agonists tend to be less effective. So if they don’t seem to be helping there is little you can do, except admit a child to hospital if they are not feeding or need oxygen. (SSC)
One in 11 children has asthma and it is the most common long-term medical condition.
On average there are three children with asthma in every classroom in the UK.
The UK has among the highest prevalence rates of asthma symptoms in children worldwide.
Asthma attacks hospitalise someone every 8 minutes; 185 people are admitted to hospital because of asthma attacks every day in the UK (a child is admitted to hospital every 20 minutes because of an asthma attack) NICE 2013
childhood asthma assessment
Often difficult to assess severity.
Consider: Duration, treatment, response to treatment, course of previous attacks
Wheeze & respiratory rate are a poor indicator.
Use of accessory muscles, recession & heart rate are a better guide.
Cyanosis, fatigue & drowsiness are a late sign, often accompanied by silent chest.
Peak flow if possible and O2 saturations.
Features of life-threatening asthma
childhood
Confusion Exhaustion Hypotension Cyanosis Poor respiratory effort O2 sats < 92 % Silent chest Peak flow < 33 % expected
Features of severe asthma childhood
Too breathless to feed/talk Cant complete sentences in one breath Recession/use of accessory muscles Resp rate > 40 / min (age 2 – 5 yrs) > 30 / min (age > 5 yrs) Pulse rate > 140 / min (age 2 – 5 yrs) > 125 / min (age > 5 yrs) Peak flow 33 - 50 % expected best SP02 < 92 %
Moderate asthma exacerbation childhood
Able to talk in sentences
SPO2 > 92 %
PEFR > 50 % best/predicted
Heart rate: < 140 / min (age 2 – 5 yrs)
< 125 / min (age > 5 yrs)
Respiratory rate: < 40 / min (age 2 – 5 yrs)
< 30 / min (> 5 yrs)
