Clinical Features of Asthma in Children Flashcards
Features of Asthma (5)
Wheeze Panting Cough SOB Variable/Reversible
Triggers of asthma (4)
URTI
Exercise
Allergen
Cold weather
Histology of Asthma (4)
Mucosal oedema of the bronchi
Infiltration of the bronchial mucosa or submucosa with inflammatory cells
Shedding of epithelium
Obstruction of peripheral airways with mucousGe
Aetiology of Asthma (4)
Genes
Inherently abnormal lungs
Early onset atopy
Later exposures (Rhinovirus, Exercise, Smoking)
Mechanism of Wheeze
Bronchoconstriction
Airway wall thickening
Luminal secretions
Children’s airways are smaller and more likely to be mucosal
What type of cough is observed in asthma
Dry
Nocturnal
Exertional
Treatment of infrequent episodic wheeze with a cold
Salbutamol
Symptoms of Bronchitis
Loose rattly cough
Vomit
Chest free of wheezes and crepitation
Self-limiting
Symptoms of Bacterial Bronchitis
Distrubed mucociliary clearance
Haemophilus culture medium
Lack of social inhibition
Symptoms of Pertussis
Cough more than 2 weeks
Coughing fits
Vomiting, colour change, Petechiae
Haematoma
2 groups of genetic associations with asthma
Immune response IL-4, IL-5, IgE
Airway genes ADAM33
What is the Grandmother Effect
If Maternal grandmother smoked there is an epigentic risk that the grandchild will develop asthma
Why is obesity a risk factor of asthma
Adipose tissue release pro-inflammatory mediators
Possible risk factors of asthma
Reduced exposure to microbes/microbial products
Indoor pollution, chemical household products
Diet
Environmental Allergens to asthma
House dust mite
Cat
Grass pollen
Its probably not asthma if:
Clubbing, cervical lymphadenopathy- Cancer
Stridor- foreign body or tumour
Asymmetrical expansion
Dull percussion note (lobar collapse, effusion)
Crepitation (bronchieactasis, CF, alveolitis, LVF)
What tests can be done to exclude COPD
Lung volume
Carbon Monoxide gas transfer
Use bronchodilator to test for reversibility
Response to oral corticosteroids (anti-inflammatory)
If spirometry is normal what is the next step?
Peak flow meter and chart twice daily for 2 weeks to monitor variability
Useful investigation for asthma
CXR, Skin prick (atopic), total and specific (UgE), FBC (eosinophilia)
How do you assess acute severe asthma
Ability to speak Heart rate Respiratory rate PEF (peak expiratory flow) Oxygen Saturation/arterial blood gas
Moderate asthma attack
Heart and respiratory rate is not raised
Normal O2 levels
PEF is low
Severe asthma attack
Raised heart and respiratory rate
Saturation and oxygen levels are maintained and normal
Life threatening asthma attack
Slow heart rate BP is low Peak flow very low Cyanosis O2 levels and saturation low Normal partial pressure Raised PaCO2
In emphysema
Lung compliance would be
Inspiration would be
Expiration would be
High- loss of elastic recoil
Increased (easier)
Reduced and difficult
