Clinical features of Asthma in Children

Question 1

If you remember one thing…

Answer 1

No wheeze, no asthma

Question 2

Key words to describe asthma?

Answer 2

Wheeze, Variability, Respond to treatment

Question 3

What are the asthmatic similarities with adults?

Answer 3

Symptoms, Common, same triggers, same treatment, same pathology

Question 4

What are asthmatic difference between children and adults?

Answer 4

Gender (most common with boys in children), severe asthma, occupational asthma uncommon.

Question 5

Effect on UK population?

Answer 5

1 million children. 100,000 in Scotland. 5% children in inhaled steroids.

Question 6

What are the main multiple ‘hits’ of asthma?

Answer 6

Genes, inherently abnormal lungs, early onset atopy, Later exposures (Rhinovirus, Exercise, smoking)

Question 7

Inconsistencies in asthma?

Answer 7

Persistance, severities, age at onset, triggers

Question 8

Explain ‘growing out’ of asthma.

Answer 8

Asthma symptoms fade as they grow up - but may come back further down the line.

Question 9

Testing in Children?

Answer 9

asthma is a diagnosis based on symptoms supported by abnormal physiology. Tests are unproven.

Question 10

What is stridor?

Answer 10

Inspiratory sound, similar to snoring.

Question 11

What are mechanisms for wheeze?

Answer 11

Bronchoconstiction, airway wall thickening, Luminal secretions, HOWEVER childrens airways are smaller and more likely to be musical.

Question 12

Explain shortness of breath at rest.

Answer 12

Significant respiratory difficulty (<30% lung function), Airway obstruction, “sucking’ in of ribs with wheeze

Question 13

Features of asthmatic cough

Answer 13

Dry, Nocturnal, exertional

Question 14

What are common triggers?

Answer 14

URTI (upper respiratory tract infections = rhinovirus), Exercise, Allergen, Cold air, Emotion and menstruation.

Question 15

Does atopy cause Asthma?

Answer 15

No. It is likely that asthma causes IgE sensitisation.

Question 16

What is an ideal diagnosis for asthma?

Answer 16

Wheeze, shortness of breath at rest, Multitrigger, atopy, parental asthma, RESPONDS TO TREATMENT.

Question 17

What are differential diagnosis for asthma?

Answer 17

Foreign body, Cystic fibrosis, Immune deficiency, Ciliary dyskinesia, tracheo-bronchomalacia

Question 18

How do you treat infrequent episodic wheeze with a cold?

Answer 18

With Salbutamol

Question 19

When is it not asthma?

Answer 19

All that is chronic and paediatric and respiratory is not asthma

Question 20

If you are under 18 moths is it most likely asthma or infection?

Answer 20

Infection

Question 21

Over 5 years, is it most likely asthma or infection?

Answer 21

Asthma

Question 22

What are features of bronchitis?

Answer 22

Common, Loose rattly cough, noisy breathing, chest free of wheeze, self-limiting, parent worried but child is VERY well

Question 23

Describe bacterial bronchitis.

Answer 23

Disturbed mucociliary clearance. Infection is secondary. Following URTI, lasts 4 weeks. First winter bad then continues to improve.
Eg rhinovirus, adenovirus,RSV

Question 24

how do you treat bacterial bronchitis?

Answer 24

You DON’T - if you give antibiotics they probably wont work and may cause diarrhoea

Question 25

What is Pertussis?

Answer 25

‘whooping cough’

Common, vaccination reduces risk, coughing fits, vomiting, colour change, Petechiae (burst blood vessels in eye)

Question 26

When its not asthma at preschool age, what could it be?

Answer 26

Bronchitis (peak at 2-3, wet cough), Tracheomalacia (life long), Cystic fibrosis, foregin body, ciliary dyskinesia, pertussis

Question 27

When its not asthma at school child age, what could it be?

Answer 27

habitual cough (8-12), Dysfunctional breathing, vocal cord dysfunction, pertussis

Question 28

How can you confirm an asthma diagnosis?

Answer 28

With inhaled corticosteroids and see if the symptoms improve