clinical features of asthma in children Flashcards
• Define asthma and highlight the differences and similarities to adult cases • Understand the epidemiology of asthma and its proven and putative aetiological factors. • Describe the clinical presentation of asthma. • Be aware of the diagnostic difficulties when assessing a child with wheeze and cough. • Recognise non asthmatic presentations of respiratory illness
things to remember about asthma
no wheeze = no asthma
if QOL affected - confirm diagnosis w/ trial of ICS
QOL not affected - watch and wait
what is asthma
chronic condition
no longer a diagnosis of exclusion
wheeze, cough, SOB
multiple trigger, variable/reversible
responds to asthma Rx
define asthma
affects all age groups but often starts in childhoof
characterised by recurrent attacks of SOB and wheeze - vary in frequency and severity from person to person
what causes asthma - pathophysiology
inflammation of the air passages in the lungs
affects the sensitivity of the nerve endings in the airways so they become easily irritated
asthma attack - lining of the passages swell, airways narrow, reduced airflow in and out of the lungs
aetiology of asthma
host response to environment
infection is important
physiology is abnormal before symptoms occur
inconsistencies in asthma
some people have transient symptoms and others have persistent symptoms
viral induced wheeze vs asthma/multi trigger wheeze
different severities, different age at onset
heterogeneity in response
different triggers
causes of asthma - genetics
30-80% of causation
~10 variants make modest contribution
ADAM33, ORMDL3
interact w/ environment
allergies causing asthma
the allergy itself doesn’t cause the asthma straight away
1y epithelial abnormality (skin, airway, gut) then results in:
- eczema/asthma etc
- allergy
allergy then fuels eczema/asthma etc
epidemiology of asthma
1.1 mln children UK
110 000 Scotland
5% of UK children on ICS
environment and asthma
western lifestyle is associated with increased asthma risk
parents w/ asthma - intervention strategies reduced asthma risk in children
- reduced allergen exposure by envouraging breastfeeding, late weaning, removal of pets, removal of house dust mites
- smoking cessation
when is it asthma - assessing the child
hx - also consider parental hx of asthma and PMH (eczema, hay fever, food allergies)
examination is unhelpful - unlikely to be wheezing
no diagnostic asthma test in children - peak flow, allergy tests, spirometry and exhaled NO are all unhelpful/limited use
tests can be useful for exclusion of other conditions
spirometry and bronchodilator response
baseline spirometry
administer bronchodialtory agent
reassess spirometry and look for change
asthma diagnosis - NICE guidelines
- spirometry: in children w/ Sx, consider BDR if spirometry shows obstruction
- if child unable to perform objective tests: treat based on observation and clinical judgement, repeat tests every 6-12mths
-
FeNO: if diagnostic uncertainty still after spirometry and BDR
- peak flow: if diagnostic uncertainty still after FeNO, monitor peak flow variability for 2-4wks
wheeze in asthma
wheeze is necessary for diagnosis - but not in isolation
- check it is actually a wheeze and not other (rattle, stridor etc)
coughs in asthma
cough variant asthma doesn’t exist in children
cough predominant asthma isn’t uncommon
asthmatic cough - dry, nocturnal, exertional
approach to wheeze
approach to a pre-school cough
