Childhood asthma Flashcards
if the child doesn’t wheeze.. they don’t have?
asthma
If symptoms affect quality of life , give a trial of?
inhaled steroids
what is asthma?
wheeze, cough and SOB
- multiple triggers
- variable/ reversible
- responds to treatment
what can be a trigger of asthma?
URTI
what causes asthma? (4 key points)
- host response to an environment
- abnormal response to infections
- Physiology abnormal before symptoms
- It is a syndrome
different asthma syndromes? (5)
- infant onset (bronchiolitis)
- childhood onset (eczema )
- adult onset (40’s)
- exceptional asthma
- occupational asthma
genes causing asthma - variants? (2)
ADAM33, ORMDL3
what primary Primary epithelial abnormalities (skin/airway/gut) result in asthma? (2)
Eczema/asthma/etc
Allergy (hay fever)
number of children in uk on asthma medication?
1 in 20
What babies are at risk of asthma?
- parents have asthma!!
- feeding - breast - late weening
- allergen (ante and post natal)
smoking
some tests for asthma (not diagnostic)
- Peak flow random number generator
- Allergy tests irrelevant
- Spirometry lacks specificity
- Exhaled nitric oxide unproven
nitric oxide
airway eosinophilia - allergic blood cells
- how much allergy inflammation in the lungs
- skin prick test, IgE
start value for spirometry?
1.09
exhaled nitric oxide starting value?
2.30
Asthma diagnosis - NICE
- spirometry
- brunch-dialtor response - short acting blue inhaler
- FeNO
- peak flow
what is a wheeze?
polyphonic
- wheeze , cough, episodes of SOB
children with croup can come in with ?
stridor
most common noises?
rate of bronchitis
whistle of wheeze
SOB at rest when lung function is?
<30& lung function down
- looking in of the ribs, tummy sticks out
cough associated with asthma? (3)
dry cough
comes on at night
exceptional
circumstantial evidence
parents using inhalers - history of allergy (Eczema) (Hayfever) (Food allergies)
first line treatment for expected asthma
2 month course of ICS
- give a brown inhaler - need to carry on using it
if symptoms go away after using brown inhaler.. stop and?
2-3 months - symptoms away - do symptoms come back?
- if they don’t = false positive
to diagnose asthma: criteria (4)
- Wheeze (with and without URTI)
- SOB@rest
- Parental asthma
- Responds to treatment
harm of treatment?
Cost
Hassle
0.5-1cm loss in height
Oral thrush
Benefits of treatment?
- Helps diagnosis
- If symptoms respond:
Improves QoL
Reduces risk of attacks
approach to wheeze?
if it is a whistle
- trial of ICS - 2 months
When is it not asthma?
- Under 18 months, most likely infection
- Over 5 years, most likely asthma
onset under 5 years - differentials for asthma (5)
- Congenital
- CF
- PCD
- Bronchitis
- Foreign body
Onset ≥ five years - differentials (4)
- Dysfunctional breathing
- Vocal cord dysfunction
- Habitual cough
- Pertussis
asthma vs Viral induced wheeze
- Preschool children (99%)
- Different shades of the same colour
- The child does not care what u call it!
- Should be treated
viral induced wheeze with….
a cold
preschool cough - moist ?
Bacterial bronchitis
red flag - bronchiectasis
preschool - dry cough
Pertussis
