Childhood Asthma

Question 1

If a child is suspected to have asthma but it is not affecting their quality of life, what is the best management strategy?

Answer 1

Watch and see

Question 2

If a child is suspected to have asthma & it is affecting their quality of life, what is the best management strategy?

Answer 2

trial of inhaled corticosteroids

Question 3

Which three clinical features are required before a diagnosis of asthma can be made?

Answer 3

wheeze, cough and shortness of breath

Question 4

What % of asthma causation is hereditary?

Answer 4

80%

Question 5

What are the two genes associated with asthma?

Answer 5

ADAM33 & ORMDL3

Question 6

Explain the pathophysiology of allergic asthma

Answer 6

A primary epithelial abnormality in the skin/airway/gut allows allergens (that should have been blocked by these epithelial barriers) allows the allergen to interact with the immune system.

The allergen then interacts with the immune system and fuels asthma or eczema

Question 7

How many children in the UK and in Scotland suffer from asthma?

Answer 7

1.1 million UK children

110,000 Scottish children

Question 8

What % of UK children are on inhaled corticosteroids?

Answer 8

5%

Question 9

In which region of the world is asthma burden the highest? Why/

Answer 9

Western regions (due to limited genetic diversity)

Question 10

`How much does lung function need to have fallen by before asthmatic children are short of breath at rest?

Answer 10

30%

Question 11

List three typical features of an asthmatic cough

Answer 11

dry
nocturnal
exertional

Question 12

Explain the concept of an inhaler holiday

Answer 12

If symptoms have gone away with the use of the brown inhaler for 2 months (inhaled corticosteroids) ask them to stop taking it (try to time it with springtime) and see if the symptoms come back
If the symptoms don’t come back, it’s not asthma

Question 13

How do you differentiate asthma from a viral induced wheeze?

Answer 13

Clinical presentations are similar except a child with viral induced wheeze only wheezes when they have a cold.

Question 14

How is viral induced wheeze managed?

Answer 14

bronchodilators and inhaled corticosteroids

Question 15

What are the 5 goals that asthma treatment hope to achieve?

Answer 15

1. “Minimal” symptoms during day and night
2. Minimal need for reliever medication
3. No attacks (exacerbations)
4. No limitation of physical activity
5. There is no cure for asthma, only palliation or spontaneous resolution

Question 16

How is asthma control measured?

Answer 16

Use the SANE acronym to investigate asthma control

• Short acting beta agonist (are you using your blue inhaler more than to days a week? If yes, the asthma is poorly controlled)
• Absence school/nursery (have you been absent from school or nursery due to asthma?)
• Nocturnal symptoms (are you waking on more than one night a week due to a cough or a wheeze?)
• Exertional symptoms (how many days a week does Asthma flare up due to exertion)

Question 17

When should treatment be considered for step down?

Answer 17

if the patient has been stable for >3 months, consider stepping treatment down

Question 18

What are the three considerations when a patients asthma is poorly controlled?

Answer 18

• Are they taking the treatment?
• Are they taking the treatment properly?
• Is the diagnosis of asthma correct?

Question 19

What are the standard medications prescribed to manage asthma?

Answer 19

Short acting beta agonist (blue inhaler)

ICS (brown inhaler)

Question 20

What are the side effects/risks of ICS?

Answer 20

Very minimal risks; very small reduction in height, risk of oral candidiasis and risk of adrenocortical suppression

Question 21

What are the 4 add on medications used in childhood asthma management?

Answer 21

Long acting beta agonists (don’t use with ICS!)
Leukotrine receptor agonists
Theophyllines
Oral steroids

Question 22

What is the maximum does of ICS that can be prescribed in children <12 years old?

Answer 22

800mg

Question 23

What is the first line preventer medication in children <5?

Answer 23

leyukotrine receptor agonists

Question 24

Can long acting receptor agonists be used in pads?

Answer 24

No

Question 25

What are the two drug delivery systems used in paediatric asthma?

Answer 25

Metres dose inhaler with a spacer

Dry powder device

Question 26

What environmental changes can help in paediatric asthma?

Answer 26

Reduce tobacco smoke exposure

Remove pets

Question 27

What medications should be given in a mild acute asthma attack?

Answer 27

Short acting beta agonists via Spacer

Short acting beta agonists via spacer + oral prednisolone

Question 28

What medications should be given in a moderate acute asthma attack?

Answer 28

Short acting beta agonists via neb + oral prednisolone

Short acting beta agonists + ipratropium bromide via neb + oral prednisolone

Question 29

What medications should be given in a Severe acute asthma attack

Answer 29

• IV salbutamol
• IV aminophylline
• IV magnesium (neb)
• IV hydrocortisone
• Intubate & ventilate – Uncommon and unusual

Question 30

Explain the difference in steroid administration in chronic vs acute asthma

Answer 30

Chronic/ maintenance treatment = inhaled steroids (not oral steroids)

Acute treatment = oral steroids (not inhaled steroids)