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year three - paediatrics > Chronic Asthma > Flashcards

Chronic Asthma Flashcards

1
Q

What is asthma?

A

It is a chronic inflammatory airway disease
leading to variable airway obstruction

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2
Q

What hypersensitivity reaction is associated with asthma?

A

Type 1

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3
Q

What is the pathophyiosology of asthma?

A

In asthma patients, the smooth muscle within the airways is hypersensitive, responding to stimuli by constricting and therefore causing airflow obstruction

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4
Q

What is the key characteristic feature of the bronchoconstrcition associated with asthma?

A

It is reversible

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5
Q

What are the eight risk factors of asthma?

A

Atopy Personal/Family History

Antenatal Factors

Low Birth Weight

Bottle Feeding

Obesity

Allergen Exposure

Air Pollution

Hygiene Hypothesis

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6
Q

What is atopy?

A

It is defined as the body’s predisposition to develop an antibody called immunoglobulin E in response to environmental allergens

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7
Q

What is more influential - maternal or paternal atopy?

A

Maternal

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8
Q

What are the three main atopic conditions?

A

Asthma

Atopic dermatitis (eczema)

Allergic rhinitis (hayfever)

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9
Q

What two genes are associated with asthma?

A

ADAM33

ORMDL3

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10
Q

What two antenatal risk factors are associated with asthma?

A

Maternal Smoking

Viral Infection

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11
Q

What antenatal viral infection is most commonly associated with asthma?

A

RSV

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12
Q

What is the hygiene hypothesis?

A

It refers to reduced exposure to infectious agents in childhood resulting in abnormal development of the immune system - specifically resulting in a Th2 predominant response

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13
Q

What are the three clinical features of asthma?

A

Dry Cough

Dyspnoea

Bilateral Expiratory Wheeze

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14
Q

What are the two characteristics of the clinical features associated with asthma?

A

Episodic

Diurnal variability - worse in the early morning and night

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15
Q

List seven common triggers of asthma

A

Infection

Dust

Exercise

Animals

Smoking

Cold air

Food allergens

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16
Q

What three food allergens commonly trigger asthma?

A

Peanuts

Shellfish

Eggs

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17
Q

In most cases how is asthma diagnosed?

A

Clinically

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18
Q

What four investigations can be used to confirm a diagnosis of asthma?

A

Spirometry

Peak Flow Meter

Fractional Exhaled Nitric Oxide (FeNO)

Direct Bronchial Challenge Test

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19
Q

What two things need to be proven through investigations, in order to confirm a diagnosis of asthma?

A

Airflow obstruction

Airflow obstruction reversibility

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20
Q

What is spirometry?

A

It is an investigation that measures the volume and flow of air during exhalation and inhalation

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21
Q

What three metrics are obtained from spirometry?

A

Forced Expiratory Volume 1 (FEV1)

Forced Vital Capacity (FVC)

FEV1 : FVC

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22
Q

What is FEV1?

A

It is defined as the volume that has been exhaled at the end of the first second of forced expiration

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23
Q

What is FVC?

A

It is defined as the volume that has been exhaled after a maximal expiration, following a full inspiration

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24
Q

In which age group can we conduct spirometry in?

A

> 5 yrs old

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25
Q

What three spirometry results indicate a diagnosis of asthma?

A

Reduced FEV1

Normal FVC

FEV1 : FVC < 70%

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26
Q

Following abnormal spirometry results, what should be tested?

A

We test the reversibility of airflow obstruction

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27
Q

In what two ways can we test reversibility of airflow obstruction with spirometry?

A

Bronchodilator response

Corticosteroid response

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28
Q

Describe how bronchodilators can be used to test the reversibility of airflow obstruction in spirometry

A

We administer 400ug inhaled salbutamol or 2.5-5mg nebulised salbutamol

We conduct spirometry tests 15 minutes following administration

The results are deemed to demonstrate reversibility when FEV1 > 400ml

29
Q

Describe how corticosteroids can be used to test the reversibility of airflow obstruction in spirometry

A

We administer 30mg oral prednisolone for a period of 14 days or 500mcg inhaled beclomethasone for a period of 6 weeks

The results are deemed to demonstrate reversibility when FEV1 > 400ml

30
Q

What are peak flow meter tests?

A

They involve the patients blowing as hard and as fast as they can into a small handheld device

This measures the rate at which air is exhaled from the lungs, obtaining a peak expiratory flow (PEF) score in litres of air breathed out per minute

31
Q

How can peak flow meter tests be used to diagnose asthma?

A

We ask patients to conduct peak flow meter readings at home twice daily for a period of 2 – 4 weeks

These readings are then plotted upon a chart, which incorporate the patient’s age, height and sex

32
Q

What three peak flow meter test results indicate asthma?

A

Morning/nocturnal dips

A gradual decline of results over

A variability of results greater than 20% on more than 3 consecutive days of the week

33
Q

What are FeNO tests?

A

They measure the level of nitric oxide in the exhaled breath, providing information about the eosinophilic inflammation in the lungs

34
Q

How do FeNo test results provide information about eosinophilic inflammation in the lungs?

A

This is due to the fact that nitric oxide is produced by inducible nitric oxide synthase (iNOS), with levels increasing in inflammatory cells – particularly eosinophils

Therefore, the level of nitric oxide correlated with the levels of inflammation.

35
Q

What is a direct bronchial challenge test?

A

It involves gradually increasing doses of medications that can irritate the airways to precipitate airway constriction

It therefore measures hypersensitivity of the airways

36
Q

What three medications can be used in direct bronchial challenge tests?

A

Histamine

Methacholine

Mannitol

37
Q

What direct bronchial challenge results indicate a diagnosis of asthma?

A

There are reduced medication doses required to precipitate constriction

38
Q

At what age do children need to be before they can obtain a diagnosis of asthma?

A

2-3 yrs old

39
Q

What are the five pharmacological management options of asthma?

A

Short Acting Beta-2 Agonists (SABA)

Inhaled Corticosteroids (ICS)

Long Acting Beta-2 Agonists (LABA)

Leukotriene Receptor Antagonists (LTRA)

Maintenance & Reliever Therapy (MART)

40
Q

Name two SABA inhalers

A

Salbutamol

Terbutaline

41
Q

Salbutamol is what inhaler colour?

A

Blue

42
Q

When are SABA inhalers used to treat asthma?

A

They are the first line pharmacological option

43
Q

What is another term for SABA inhalers? Why?

A

Reliever inhalers

They are used to relieve acute asthma features as required

44
Q

What is the mechanism of action of SABA inhalers?

A

The adrenalin in these inhalers works to relax the smooth muscles within the airways

45
Q

What is the main side effect of SABA?

A

Tremor

46
Q

Name two ICS inhalers

A

Beclomethasone dipropionate

Fluticasone propionate

47
Q

Beclomethasone dipropionate is what colour of inhaler?

A

Brown

48
Q

Fluticasone propionate is what colour of inhaler?

A

Purple

49
Q

When are ICS inhalers used to treat asthma?

A

They are the second line pharmacological option

50
Q

What is another term for ICS inhalers? Why?

A

Preventor inhalers

They should be administered by the patient every day regardless of whether the patient experiences asthma features

51
Q

At what frequency should ICS inhalers be initially administered?

A

Twice daily

52
Q

What are the two side effects of ICS inhalers?

A

Oral candidiasis

Stunted growth

53
Q

Name a LABA inhaler

A

Salmeterol

54
Q

When are LABA inhalers used to treat asthma?

A

They are the fourth line pharmacological option

55
Q

What is another term for LABA inhalers? Why?

A

Preventer inhalers

They should be administered by the patient every day regardless of whether the patient experiences asthma features

56
Q

What is the mechanism of action of LABA?

A

The adrenalin in these inhalers works to relax the smooth muscles within the airways

57
Q

Name an LTRA

A

Oral montelekast

58
Q

When are LTRAs used to treat asthma?

A

They are the third line pharmacological option

59
Q

What is the mechanism of action of LTRAs?

A

Leukotrienes are produced by the immune system to cause inflammation, bronchoconstriction and mucus secretion

LTRAs inhibit leukotrienes and therefore prevent its effects

60
Q

What is MART?

A

It is a form of combined inhaled corticosteroid and long acting beta-2 agonist treatment in a single inhaler

61
Q

How do we administer MART?

A

It can be administered for both daily maintenance therapy and to relieve acute asthma features as required

62
Q

When do we administer MART?

A

It is only recommended in individuals who have poorly controlled asthma

63
Q

What are the four stepwise management options for asthma in < 5 yrs old?

A

SABA Inhaler As Required

Add An ICS Inhaler OR Oral LTRA

Add The Other Option From Step Two

Specialist Referral

64
Q

What are the five stepwise management options for asthma in children between 5 - 12 yrs old?

A

SABA Inhaler As Required

Add An ICS Inhaler

Add An Oral LTRA OR LABA Inhaler

Titrate Up The ICS Inhaler Dose Or Add The Other Option From Step Three

Specialist Referral

65
Q

What are the five stepwise management options for asthma > 12 yrs old?

A

SABA Inhaler As Required

Add An ICS Inhaler OR MART Inhaler

Add A LABA Inhaler

Titrate Up The ICS Inhaler Dose Or Add An Oral LTRA

Specialist Referral

66
Q

How do we monitor the efficiency of asthma management?

A

It is based upon the patient’s clinical history, rather than a specific investigation

For example, in patients who are requiring more than three doses of their SABA inhaler per week, we would recommend that their medication is reviewed accordingly

67
Q

When do we recommend that paediatric asthma patients are not started on inhalers? Why?

A

Easter

This is due to their return back to school at this time resulting in a lot of children falling ill

This means that it can be difficult to tell whether their treatment is ineffective or they are ill

68
Q

What complication occurs when patients have a poor inhaler technique?

A

Oral candidiasis

year three - paediatrics (29 decks)

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