Clinical features and management of Asthma in Children Flashcards
How is asthma diagnosed?
Wheeze
Variable airway obstruction
SOB at rest
Respond to treatment (Often ICS trial)
What are some causes of asthma?
Genes (ADAM33, ORMDL3) Environment Epigenetics Smoking Late weaning Allergy
What are some common presentations of asthma in children?
Coughs a lot
Recurrent “chest infections”
Always at the doctor for a wheezy cough
Always chesty
What do we do if QoL is not affected by symptoms?
Watch and wait
Many grow out of symptoms without need for medication
When are tests useful for asthma?
Mostly for excluding other causes
What is a drawback of spirometry for asthma?
Lacks specificity
What is the NICE recommended testing path for children with high index of suspicion for asthma?
Spirometry
Bronchodilator response (blue inhaler)
Nitric oxide
Peak flow
What are some associations with asthma in children?
Parental history
Eczema
Hayfever
Food allergies
What are the most likely causes for an asthma-like presentation in differ
Infection
What is the differential diagnosis for onset under 5 years?
Congenital CF PCD Bronchitis Foreign body
What is the differential diagnosis for onset over 5 years old?
Dysfunctional breathing
Vocal cord dysfunction
Habitual cough
Pertussis
What is a suspicion when there are red flags present?
Bronchiectasis
What is step 1 after diagnosis from monitored trial of very low dose ICS?
Low does ICS
LTRA for <5
What is step 2 after ICS or LTRA added?
Add inhaled LABA
LTRA for <5
What is step 3 for no response to LABA?
If Stop LABA and increase ICS to low dose
What is step 3 for limited response to LABA?
Continue LABA and increase ICS to low dose
Consider trial of other therapy like LTRA
What is step 4 for high dose therapies?
Consider trial of increasing ICS to medium dose
Addition of 4th drug like SR theophylline
Which medication is maintained throughout all steps of asthma treatment?
SABA
E.g. salbutamol
When do you need to start going through the steps of preventer meds?
After diagnosis start on SABA
If SABA is used more than twice per week then start on preventer
What are some adverse effects of ICS?
Height suppression
Oral candidiasis
Adrenocortical suppression
What are 2 things to remember for LABA?
Do not use with ICS
Use as fixed dose inhaler
What are benefits of using a spacer?
4x more meds get through
Why do you need to shake the inhaler before and between puffs?
2x more meds
Why do you need to wash spacers?
2x meds compared to no wash
What are some benefits of MDI spacer over nebuliser?
Quieter Quicker Valve mechanism Don’t break down Portable Cheaper
What is the escalation of acute asthma treatment?
SABA via spacer + pred
SABA via neb + pred
IV salbutamol/ aminophylline/ magnesium/ hydrocortisone
Intubate and ventilate
Start treatment then reassess after 1 hour
How do you assess acute attack severity and hence decide treatment?
Respiratory rate Work of breathing Heart rate Oxygen saturations Ability to complete sentences Confusion Air entry
How does steroid use for acute vs chronic treatment?
Inhaled for chronic
Oral for acute
