Childhood Asthma Flashcards
If a child is suspected to have asthma but it is not affecting their quality of life, what is the best management strategy?
Watch and see
If a child is suspected to have asthma & it is affecting their quality of life, what is the best management strategy?
trial of inhaled corticosteroids
Which three clinical features are required before a diagnosis of asthma can be made?
wheeze, cough and shortness of breath
What % of asthma causation is hereditary?
80%
What are the two genes associated with asthma?
ADAM33 & ORMDL3
Explain the pathophysiology of allergic asthma
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
How many children in the UK and in Scotland suffer from asthma?
1.1 million UK children
110,000 Scottish children
What % of UK children are on inhaled corticosteroids?
5%
In which region of the world is asthma burden the highest? Why/
Western regions (due to limited genetic diversity)
`How much does lung function need to have fallen by before asthmatic children are short of breath at rest?
30%
List three typical features of an asthmatic cough
dry
nocturnal
exertional
Explain the concept of an inhaler holiday
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
How do you differentiate asthma from a viral induced wheeze?
Clinical presentations are similar except a child with viral induced wheeze only wheezes when they have a cold.
How is viral induced wheeze managed?
bronchodilators and inhaled corticosteroids
What are the 5 goals that asthma treatment hope to achieve?
- “Minimal” symptoms during day and night
- Minimal need for reliever medication
- No attacks (exacerbations)
- No limitation of physical activity
- There is no cure for asthma, only palliation or spontaneous resolution
How is asthma control measured?
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)
When should treatment be considered for step down?
if the patient has been stable for >3 months, consider stepping treatment down
What are the three considerations when a patients asthma is poorly controlled?
- Are they taking the treatment?
- Are they taking the treatment properly?
- Is the diagnosis of asthma correct?
What are the standard medications prescribed to manage asthma?
Short acting beta agonist (blue inhaler)
ICS (brown inhaler)
What are the side effects/risks of ICS?
Very minimal risks; very small reduction in height, risk of oral candidiasis and risk of adrenocortical suppression
What are the 4 add on medications used in childhood asthma management?
Long acting beta agonists (don’t use with ICS!)
Leukotrine receptor agonists
Theophyllines
Oral steroids
What is the maximum does of ICS that can be prescribed in children <12 years old?
800mg
What is the first line preventer medication in children <5?
leyukotrine receptor agonists
Can long acting receptor agonists be used in pads?
No
What are the two drug delivery systems used in paediatric asthma?
Metres dose inhaler with a spacer
Dry powder device
What environmental changes can help in paediatric asthma?
Reduce tobacco smoke exposure
Remove pets
What medications should be given in a mild acute asthma attack?
Short acting beta agonists via Spacer
Short acting beta agonists via spacer + oral prednisolone
What medications should be given in a moderate acute asthma attack?
Short acting beta agonists via neb + oral prednisolone
Short acting beta agonists + ipratropium bromide via neb + oral prednisolone
What medications should be given in a Severe acute asthma attack
- IV salbutamol
- IV aminophylline
- IV magnesium (neb)
- IV hydrocortisone
- Intubate & ventilate – Uncommon and unusual
Explain the difference in steroid administration in chronic vs acute asthma
Chronic/ maintenance treatment = inhaled steroids (not oral steroids)
Acute treatment = oral steroids (not inhaled steroids)
