Clinical Features Of Asthma In Children

Question 1

Describe the symptoms of an acute asthma attack.

Answer 1

Coughing, shortness of breath, and noisy breathing.

Question 2

Define asthma.

Answer 2

A chronic condition characterized by wheezing, coughing, and shortness of breath, often triggered by upper respiratory tract infections.

Question 3

How is asthma characterized by its variability and reversibility?

Answer 3

It can be present at different times of the day, year, or life course, and it responds to asthma treatment.

Question 4

Do tests help in decision making for asthma diagnosis?

Answer 4

Tests may not help decision making, and a trial of inhaled steroids may be needed to confirm the diagnosis.

Question 5

Describe the pattern of relapse and remission in asthma.

Answer 5

Asthma can have periods of relapse and remission, lasting for months, years, or even decades.

Question 6

What is the key missing element in the bottom asthma definition?

Answer 6

The symptom of wheeze, variability, and response to treatment.

Question 7

Describe the WHO’s definition asthma.

Answer 7

The WHO defines asthma as a condition that often starts in childhood with variable symptoms and a key association with wheezing, variability and response to treatment.

Question 8

Do we know the exact cause of asthma?

Answer 8

No, the exact cause of asthma is not known, but it is believed to be related to the host’s response to the environment, including abnormal responses to infections.

Question 9

Define asthma in terms of its common pathway and inconsistencies.

Answer 9

Asthma is described as a condition with a common pathway in terms of symptoms and treatment response, but with diverse routes leading to this final pathway and many inconsistencies.

Question 10

How does asthma manifest in different individuals?

Answer 10

Asthma can manifest differently in individuals, with some experiencing transient symptoms, others having persistent symptoms, and different triggers leading to the condition.

Question 11

Describe the different settings and triggers in which asthma can develop.

Answer 11

Asthma can develop in various settings, such as in childhood after bronchitis, with eczema, in adulthood, during intense physical activity, or due to occupational exposures like working in a bakery or with latex gloves.

Question 12

What are the key characteristics of asthma syndrome?

Answer 12

Asthma syndrome involves a series of multiple hits, with no single cause, resulting in common symptoms that respond to common treatment, despite the diverse triggers and timings of onset.

Question 13

Describe the role of hereditary factors in asthma causation.

Answer 13

Up to 80% of asthma causation can be explained by hereditary factors, with at least 10 genetic variants making a modest contribution to the overall burden of asthma.

Question 14

How do genetic variants contribute to asthma risk?

Answer 14

Genetic variants, such as ADAM33 and ORMDL3, are consistently associated with asthma risk, but not all individuals with these genes develop asthma. The interaction with the environment is crucial.

Question 15

Define epigenetics and its relevance to asthma.

Answer 15

Epigenetics explains why individuals with the same genetic material can look different due to genes being switched on and off. It is rapidly becoming recognized as a potential factor in asthma development.

Question 16

Do allergies directly cause asthma?

Answer 16

Almost certainly not. The link between allergy and asthma is likely due to a primary abnormality in the skin of the airway, allowing allergens to enter the immune system and trigger allergic sensitization.

Question 17

Describe the relationship between allergic sensitization and asthma symptoms.

Answer 17

Allergic sensitization leads to the development of symptoms in the affected organ, such as the skin, colon, or gut. The sequence of events involves a problem with the epithelium, allergic sensitization, and the subsequent fueling of symptoms.

Question 18

What is the epidemiological status of asthma in the UK?

Answer 18

Asthma is a very common condition in the UK, with a high burden despite the lack of a clear definition and diagnostic test. In the late 90s, the UK had the highest burden of asthma in the world, with a significant number of children receiving preventative asthma treatment.

Question 19

Describe the prevalence of lifetime asthma in children aged seven to 11 in Aberdeen.

Answer 19

A survey in 1964 followed by a 25-year follow-up revealed the prevalence of lifetime asthma in children aged seven to 11 in Aberdeen, demonstrating the long-term epidemiological trends of asthma in this age group.

Question 20

Explain the concept of ‘genes loading the gun, and the environment pulling the trigger’ in relation to asthma.

Answer 20

This concept highlights that while individuals may be genetically predisposed to asthma, it is the encounter with an environment that triggers the manifestation of asthma symptoms. The environment plays a crucial role in the development of asthma despite genetic predisposition.

Question 21

Describe the rise and fall of asthma prevalence in Aberdeen.

Answer 21

Asthma prevalence in Aberdeen rose to one in three children in 2004, before starting to come down. This rise was attributed to diagnostic enthusiasm and a shift in recognizing asthma in children.

Question 22

What are some possible reasons for the rise in asthma prevalence between the 60s and 80s?

Answer 22

Possible reasons for the rise in asthma prevalence include increasing hygiene, dietary changes, and westernization.

Question 23

How does lifestyle influence the risk of asthma?

Answer 23

Western lifestyle is associated with an increased risk of asthma, particularly in the first three years of life, as shown by studies comparing individuals in different regions.

Question 24

Define the term ‘diagnostic enthusiasm’ in the context of asthma prevalence.

Answer 24

Diagnostic enthusiasm refers to the increased recognition and diagnosis of asthma, often leading to overdiagnosis due to a lack of clear diagnostic criteria.

Question 25

Do randomized controlled trials provide proof of causation for childhood asthma?

Answer 25

Yes, two trials have proven that the early environment causes childhood asthma, particularly in children with a family history of asthma.

Question 26

Describe the complex intervention given to parents to reduce the risk of asthma in their children.

Answer 26

The intervention involved reducing exposure to ingested allergens by encouraging breastfeeding, keeping mothers dairy-free during breastfeeding, and introducing weaning late.

Question 27

Describe the interventions mentioned to reduce allergen exposure for asthma prevention.

Answer 27

The interventions include reducing pet exposure, removing house dust mites, and encouraging parents to stop smoking.

Question 28

What is the significance of early life exposures in reducing the risk for asthma causation?

Answer 28

Early life exposures play a crucial role in reducing the risk for asthma causation in populations, as demonstrated in the Isle of Wight in the UK and Toronto.

Question 29

Define NCDs (non-communicable diseases) and their association with reduced birth weight.

Answer 29

NCDs are non-communicable diseases such as ischemic heart disease, diabetes, COPD, asthma, cancer, and dementia. Reduced birth weight is associated with these conditions.

Question 30

How does the Kaplan Meier survival curve relate to lung function and smoking?

Answer 30

The Kaplan Meier survival curve shows that after the age of 25, lung function gradually declines. Smoking can offset the harmful effects, but not everyone reaches 100% lung function, and some individuals may experience disability and early death due to respiratory issues.

Question 31

Do allergy tests help diagnose asthma?

Answer 31

Allergy tests are good for diagnosing allergies, but not for diagnosing asthma, as the majority of people with allergies do not have asthma, and 25% of people with asthma do not have allergies.

Question 32

Describe the diagnostic tests mentioned for asthma.

Answer 32

The diagnostic tests mentioned include peak flow variability, spirometry, and inhaled steroid trials to assess the impact on quality of life.

Question 33

What is the role of spirometry in diagnosing asthma?

Answer 33

Spirometry is a breathing test that can help diagnose asthma, but it has limitations in specificity, as a normal result does not rule out the possibility of asthma.

Question 34

How does early life impact later respiratory lifecourse?

Answer 34

Early life plays a significant role in determining the later respiratory lifecourse, as demonstrated by studies following populations from childhood into asthma, showing increased risk for COPD and childhood asthma.

Question 35

Describe the use of exhaled nitric oxide as a test in diagnosing childhood asthma.

Answer 35

Exhaled nitric oxide is used as a surrogate for airway inflammation and can indicate the level of allergic inflammation in the lungs, which may be helpful in diagnosing childhood asthma.

Question 36

What is the purpose of spirometry in diagnosing asthma?

Answer 36

Spirometry is used to measure lung function and can be more useful when done with a bronchodilator response to assess the change in lung function after administering asthma medication.

Question 37

Define the bronchodilator response test in the context of diagnosing asthma.

Answer 37

The bronchodilator response test measures the response to a short-acting blue inhaler, assessing the spirometry response to the inhaler to determine its effectiveness in improving lung function.

Question 38

How do the National Institute for Clinical Efficacy guidelines approach diagnosing asthma in children?

Answer 38

The guidelines recommend a comprehensive approach including clinical suspicion assessment, spirometry, bronchodilator response test, exhaled nitric oxide test, and peak flow measurement.

Question 39

Describe the approach of the BHS sign guidelines in diagnosing asthma.

Answer 39

The BHS sign guidelines also recommend a comprehensive approach with high, intermediate, and low probability assessments, emphasizing the nuanced nature of asthma diagnosis and the importance of clinical judgment.

Question 40

What is the role of clinical judgment in diagnosing asthma, as mentioned in the content?

Answer 40

Clinical judgment is crucial in diagnosing asthma, especially in young children, as reliable tests lack sensitivity and specificity, and there is a need for objective testing alongside clinical assessment.

Question 41

Describe the characteristics of wheezing in the context of asthma.

Answer 41

Wheezing in asthma is characterized by polyphonic musical sounds similar to blowing air through different caliber tubes, and it is often accompanied by coughing and episodes of shortness of breath.

Question 42

What is cough variant asthma, and does it exist in children?

Answer 42

Cough variant asthma is a form of asthma characterized by a persistent cough as the main symptom. While it exists in adults, it is mentioned that it does not exist in children in the provided content.

Question 43

Describe the different noises that be described as wheezes in children.

Answer 43

Rattles, inaudible noises snoring noises, strider, and noises made during breathing may all be described asezes by the lay public.

Question 44

Do all children who wheeze actually have asthma?

Answer 44

No, only 10% of people who have a cough have asthma, and not all children who wheeze have asthma.

Question 45

Define shortness of breath in the context of asthma.

Answer 45

Shortness of breath is a significant feature of asthma and may occur when a person has 30% of their lung function reduced.

Question 46

How long does it take for inhaled steroids to have a maximal effect in treating asthma?

Answer 46

It takes a two-month course of inhaled steroids for them to have the maximal effect in treating asthma.

Question 47

Describe the importance of clarifying the term ‘wheeze’ in diagnosing asthma.

Answer 47

It is important to clarify the term ‘wheeze’ as 75% of children said to wheeze actually rattle, and the term ‘wheeze’ may be used to describe various noises made during breathing.

Question 48

What are some circumstantial evidence that may indicate a diagnosis of asthma?

Answer 48

Circumstantial evidence for a diagnosis of asthma includes a parental history of asthma, a personal history of allergy, and a cough that tends to come in at night and is brought on by exercise.

Question 49

Describe the approach diagnosing asthma based on the symptoms and response to treatment.

Answer 49

The diagnosis of asthma involves assessing the patient’s history of wheeze, episodes of shortness of breath, and response to treatment. A clinical suspicion of asthma that responds to treatment is crucial, and a parental history of asthma can also be helpful.

Question 50

What are the potential harms and benefits of using inhaled steroids for asthma treatment in children?

Answer 50

The potential harms of using inhaled steroids for asthma treatment in children include a slight loss of height and the risk of developing oral thrush. However, the benefits include aiding the diagnosis, improving the patient’s quality of life, and reducing the risk of asthma attacks.

Question 51

Define the term ‘false positive response’ in the context of diagnosing asthma.

Answer 51

A false positive response in diagnosing asthma occurs when the symptoms improve during treatment, leading to a mistaken belief that the patient has asthma. However, the symptoms may not actually be due to asthma.

Question 52

How does the age of onset of symptoms help in determining the differential diagnosis for asthma?

Answer 52

The age of onset of symptoms is crucial in determining the differential diagnosis for asthma. For example, symptoms that appear after birth may indicate a congenital problem, while symptoms that develop later may point to bronchitis as the most common differential diagnosis.

Question 53

Describe the approach to diagnosing asthma in children under 18 months old.

Answer 53

In children under 18 months old, respiratory symptoms are likely to be infectious rather than asthma. Therefore, asthma is not typically considered as a diagnosis for respiratory symptoms in this age group.

Question 54

What is the significance of a parental history of asthma in diagnosing asthma in a child?

Answer 54

A parental history of asthma can be helpful in diagnosing asthma in a child. It can provide important clues and contribute to the clinical suspicion of asthma in the child.

Question 55

Describe the clinical presentation of a child with asthma.

Answer 55

A child with asthma presents with wheezing, shortness of breath, and may have integral symptoms of wheeze with or without exercise.

Question 56

Define vocal cord dysfunction in children.

Answer 56

Vocal cord dysfunction is where children often on the sports field suddenly become acutely short of breath and may wheeze, leading to confusion with asthma.

Question 57

How do asthma and VIW (virus-induced wheeze) differ in clinical presentation?

Answer 57

Asthma and VIW are thought to be different conditions, but they both occur in children under the age of five and have similar clinical presentations, although the pattern of illness may seem different.

Question 58

Do children with bond or value squeeze eventually become bond or asthmatic, and vice versa?

Answer 58

Yes, many children with bond or value squeeze become bond or asthmatic over time, and vice versa.

Question 59

Describe the approach to preschool cough according to the content.

Answer 59

The approach to preschool cough involves differentiating between moist and dry coughs, considering associated symptoms, and giving a trial of asthma treatment if the child’s quality of life is affected.

Question 60

Define habit cough and its common confusion with asthma.

Answer 60

A habit cough is very common due to noise and context, often confused as asthma, but it is characterized by cough without a clear reason, and there’s no reason to think it is asthma.