Chronic Asthma In Children Flashcards
State some of the similarities between asthma in adults and children
- symptoms
- the fact its common
- same triggers
- same treatment
- same pathology
State the differences between asthma in adults and children
In children boys are more likely to have asthma
In adults woman are more likely to have asthma
Describe the 5 settings of asthma
- infant onset
- childhood onset
- adult onset
- exceptional asthma
- occupational asthma
Describe the ‘sum of multiple hits’
The coupling of aetiological factors that lead to asthma
- genetic
- abnormal lungs
- early onset atopy
- environment/later exposures
- rhinovirus
- exercise
- smoking
What can ‘sooking’ in of the ribs be an indication of?
Airway obstruction
Significant resp difficulty ie <30% lung function
What course of treatment should be used for an infrequent episodic wheeze with a cold?
Salbutamol
What is wheeze often mistaken for?
Rattle/stertor
Describe a common differential in a child with asthma that has parents concerned
Viral induced wheeze
Bronchitis
Describe the mechanism for wheeze in children
Caused by bronchoconstriction, airway wall thickening and luminal secretions
Children’s airways are smaller and more likely to be musical
Describe viral induced wheeze
Recurrent infection
Usually a sign of (small print)
- foreign body
- cystic fibrosis
- Immune deficiency
- Ciliary dyskinesia
- tracheo-bronchomalacia
- aspiration
Describe the most likely outcomes in children under 18 months
Most likely an infection
At what age is a child presenting asthma like symptoms most likely to have asthma?
Over 5 years is most likely asthma
Describe conditions that have an isolated cough but do not indicate asthma
- bronchitis
- pertussis
- habitual cough (8-12 year old, single loud cough)
- tracheomalacia (life long loud cough)
- small print eg CF, foreign bodies etc
Describe the signs/symptoms of bronchitis
- very common
- loose rattle cough
- noisy breathing
- post-tussive vomit
- chest free of wheeze/creps
What treatment should be carried out for bacterial bronchitis
No treatment! Self - limiting and antibiotics will only give side effects
Describe pertussis
- very common
- vaccination reduces risk
- ‘coughing fits’
- vomiting, colour change, petechiae (small red or purple spot caused by bleeding into the skin
State step 1 and 2of the NICE guidelines for treatment in children with asthma
Step 1 - Monitored initiation of very low/paeds ICS dose to confirm diagnosis
Step 2 - continue low paeds dose of ICS
State step 3 of the NICE guidelines in treating children with asthma
If child is over 5 - add long acting b-agonist
If child is under 5 - add leukotriene receptor antagonists
State step 4 of the NICE guidelines for treatment for a child with asthma
If the LABA has no effect remove it and up the ICS to a low dose
If LABA is effective keep it and up ICS dose to low
If control is bad from LABA and an upset ICS low dose add LTRA
State step 5 of the NICE guidelines in the treatment for a child with asthma
Consider trials of medium ICS dose
Consider adding SR theophylline
State step 6 of the NICE guidelines in the treatment for a child with asthma
Daily steroid tablets in lowest dose possible
Maintain medium ICS
Look for wats to get off oral steroids
Describe the adverse effect of ICS in kids
- Reduced height
- oral candidiasis
- adrenocorticol suppression
How can the level of control the patient has over their asthma be measured?
Ask them questions structure SANE
- Short Activity b-agonist/week
- Absence school/nursery
- Nocturnal symptoms/week
- Excertional symptoms/week
Describe how treatment for children with asthma constrasts with that of adults
- max dose ICS 800 microg
- no oral B2 tablet
- LTRA first line preventer in <5s
- No LAMAs
Describe MDI/spacers
A ‘chamber’ like addition to the inhaler that increases lung deposition of medication.
Describe dry powder devices
Under 8s cannot use them but licensed in over 5s
Achieve 20% lung deposition
State the treatments for mild asthma
SABA via spacer
SABA via spacer + pred
State the treatments for moderate asthma
SABA via nebuliser + pred
SABA + ipra via nebuliser + pred
