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Paediatrics > Clinical Features of Asthma in Children > Flashcards

Clinical Features of Asthma in Children Flashcards

1
Q

What are the challenges with diagnosing asthma?

A 
No definition
No tests
Two national guidelines
Symptom based
Identical to LRTI symptoms
Relapse and remission
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2
Q

What are the characteristics of asthma?

A 
Literally “panting”
Chronic
Wheeze, cough and SOB
Multiple triggers
Variable/reversible
Responds to asthma Rx
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3
Q

What is the definitions of asthma?

A

Episodic wheeze and/or cough in a clinical setting where asthma is likely and other rarer conditions have been excluded

NO LONGER A DIAGNOSIS OF EXCLUSIVE

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4
Q

What are the 3 key aspects of asthma?

A

Wheeze
Variability
Respond to treatment

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5
Q

What are the variations in asthma?

A 
“Transient” vs persistent 
VIW versus asthma/MTW
Different severities
Different age at onset
Heterogeneity in response
Different triggers
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6
Q

What are the 5 pathways to asthma?

A

1) Infant onset
2) Childhood onset
3) Adult onset
4) Exertional asthma
5) Occupational asthma

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7
Q

What causes asthma?

A

1) Genes
- 30-80% of causation
- ~10 variants making modest contribution
- ADAM33, ORMDL3
- Interact with environment
- Epigenetics

2)Allergy

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8
Q

What is the allergy sequence?

A

There is an issue with epithelium
Allergies sensitisation
Symptoms fuled (skin, lung or gut)

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9
Q

What are highly likely and unproven reasons for the rise in asthma?

A 
Highly likely:
Diagnostic enthusiasm!
Increasing recognition
True rise
Westernisation

Not proven:
Hygiene hypothesis
Dietary hypothesis

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10
Q

2 RCTs discovered risks factors for asthma in children of affected adults. What are these factors?

A

PREVENTATIVE MEASURES

Feeding

  • Breast
  • Late weaning

Allergen
-Ante- and post-natal

Smoking

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11
Q

Is examination important in diagnosing asthma?

A

No
Unlikely to be wheezing
Stethoscope never important (often unhelpful)

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12
Q

Is there a diagnostic test for asthma in children?

A 
No
Peak flow = random number generator
Allergy tests irrelevant
Spirometry lacks specificity
Exhaled nitric oxide unproven

Tests can be useful (excluding > diagnosing)

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13
Q

What is spirometry?

A

Measures how much air a person breathes out, and how quickly

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14
Q

What is exhaled nitric oxide testing?

A

It measures the amount of nitric oxide that is exhaled from a breath
Increased levels of nitric oxide are associated with swelling of lung airways.

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15
Q

What is the order of testing in asthma diagnosis in NICE?

A

1) Spirometry
2) BDR - bronchodilator reversibility
3) FeNO - fractional exhaled NO (35 ppb or more)
4) Peak flow

ASTHMA DIAGNOSIS

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16
Q

What is the order of testing in asthma diagnosis in BTS/SIGN?

A

The same as NICE

SIGN ASTHMA

17
Q

What are the issues in diagnosing under 5s?

A

Uncertainty greatest in <5s
Tests not reliable in <5s
Tests not great anyway

18
Q

Does cough variant asthma exist in children?

A

Cough variant asthma does not exist (in children)

Cough predominant asthma not uncommon

19
Q

Apart form wheeze, what are signs of asthma in children?

A

SOB at rest

  • Significant resp. difficulty (<30% lung function)
  • Airway obstruction
  • “Sooking” in of ribs with wheeze

Cough
-Dry
Nocturnal (just after falling asleep)
Exertional

Parental Hx asthma

20
Q

What are conditions associated with asthma?

A

Eczema
Hayfever
Food allergies

21
Q

What is the length of time taken for inhaled corticosteroids (ICS) to reach their full effect?

A

2 months

So must be used for this long to work out if condition responds to treatment

22
Q

What are the 4 ideal diagnostic factors?

A

Wheeze (with and without URTI)
SOB@rest
Parental asthma
Responds to treatment

23
Q

What are the pros and cons of trial treatment?

A

Cons:

  • Cost
  • Hassle
  • 0.5-1cm loss in height
  • Oral thrush

Pros:

  • Helps diagnosis
  • If symptoms respond
  • Improves QoL
  • Reduces risk of attacks
24
Q

How should you approach a wheeze?

A

WHEEZE APPROACH

25
Q

How does age affects likelihood of asthma?

A

Under 18 months, most likely infection

Over 5 years, most likely asthma

26
Q

What are the differentials for asthma in the under 5s?

A 
Congenital
CF
PCD - primary ciliary dyskinesia 
Bronchitis
Foreign body
27
Q

What are the differentials for asthma in the 5 and overs?

A

Dysfunctional breathing
Vocal cord dysfunction
Habitual cough
Pertussis

28
Q

Are asthma and virally induced wheeze different conditions?

A

No

-Both treated with bronchodilators and steroids

29
Q

How should you approach a preschool cough?

A

COUGH APPROACH

30
Q

Summary

A 
No wheeze, no asthma
Tests may help decision
If…..
-QoL affected, confirm the diagnosis with trial of ICS
-QoL not affected, watch and see

Paediatrics (37 decks)

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