Childhood asthma

Question 1

if the child doesn’t wheeze.. they don’t have?

Answer 1

asthma

Question 2

If symptoms affect quality of life , give a trial of?

Answer 2

inhaled steroids

Question 3

what is asthma?

Answer 3

wheeze, cough and SOB

• multiple triggers
• variable/ reversible
• responds to treatment

Question 4

what can be a trigger of asthma?

Answer 4

URTI

Question 5

what causes asthma? (4 key points)

Answer 5

• host response to an environment
• abnormal response to infections
• Physiology abnormal before symptoms
• It is a syndrome

Question 6

different asthma syndromes? (5)

Answer 6

• infant onset (bronchiolitis)
• childhood onset (eczema )
• adult onset (40’s)
• exceptional asthma
• occupational asthma

Question 7

genes causing asthma - variants? (2)

Answer 7

ADAM33, ORMDL3

Question 8

what primary Primary epithelial abnormalities (skin/airway/gut) result in asthma? (2)

Answer 8

Eczema/asthma/etc

Allergy (hay fever)

Question 9

number of children in uk on asthma medication?

Answer 9

1 in 20

Question 10

What babies are at risk of asthma?

Answer 10

• parents have asthma!!
• feeding - breast - late weening
• allergen (ante and post natal)

smoking

Question 11

some tests for asthma (not diagnostic)

Answer 11

• Peak flow random number generator
• Allergy tests irrelevant
• Spirometry lacks specificity
• Exhaled nitric oxide unproven

Question 12

nitric oxide

Answer 12

airway eosinophilia - allergic blood cells
- how much allergy inflammation in the lungs

• skin prick test, IgE

Question 13

start value for spirometry?

Answer 13

1.09

Question 14

exhaled nitric oxide starting value?

Answer 14

2.30

Question 15

Asthma diagnosis - NICE

Answer 15

1. spirometry
2. brunch-dialtor response - short acting blue inhaler
3. FeNO
4. peak flow

Question 16

what is a wheeze?

Answer 16

polyphonic

- wheeze , cough, episodes of SOB

Question 17

children with croup can come in with ?

Answer 17

stridor

Question 18

most common noises?

Answer 18

rate of bronchitis

whistle of wheeze

Question 19

SOB at rest when lung function is?

Answer 19

<30& lung function down

- looking in of the ribs, tummy sticks out

Question 20

cough associated with asthma? (3)

Answer 20

dry cough
comes on at night
exceptional

Question 21

circumstantial evidence

Answer 21

parents using inhalers
- history of allergy 
(Eczema)
(Hayfever)
(Food allergies)

Question 22

first line treatment for expected asthma

Answer 22

2 month course of ICS

- give a brown inhaler - need to carry on using it

Question 23

if symptoms go away after using brown inhaler.. stop and?

Answer 23

2-3 months - symptoms away - do symptoms come back?

- if they don’t = false positive

Question 24

to diagnose asthma: criteria (4)

Answer 24

• Wheeze (with and without URTI)
• SOB@rest
• Parental asthma
• Responds to treatment

Question 25

harm of treatment?

Answer 25

Cost
Hassle
0.5-1cm loss in height
Oral thrush

Question 26

Benefits of treatment?

Answer 26

• Helps diagnosis
• If symptoms respond:
  Improves QoL
  Reduces risk of attacks

Question 27

approach to wheeze?

Answer 27

if it is a whistle

- trial of ICS - 2 months

Question 28

When is it not asthma?

Answer 28

• Under 18 months, most likely infection

- Over 5 years, most likely asthma

Question 29

onset under 5 years - differentials for asthma (5)

Answer 29

• Congenital
• CF
• PCD
• Bronchitis
• Foreign body

Question 30

Onset ≥ five years - differentials (4)

Answer 30

• Dysfunctional breathing
• Vocal cord dysfunction
• Habitual cough
• Pertussis

Question 31

asthma vs Viral induced wheeze

Answer 31

• Preschool children (99%)
• Different shades of the same colour
• The child does not care what u call it!
• Should be treated

Question 32

viral induced wheeze with….

Answer 32

a cold

Question 33

preschool cough - moist ?

Answer 33

Bacterial bronchitis

red flag - bronchiectasis

Question 34

preschool - dry cough

Answer 34

Pertussis