clinical features of asthma in children

Question 1

symptoms of asthma?

Answer 1

wheeze
no wheeze, no asthma

chronic
cough, SOB
variable, reversable

Question 2

When do you test for asthma?

Answer 2

QoL affected, confirm the diagnosis with trial of ICS

QoL not affected, watch and see

Question 3

What causes asthma?

Answer 3

Host response to environment
Infection important
Physiology abnormal before symptoms
It is a syndrome

Question 4

does everyone get affected by asthma the same way?

Answer 4

NO! many inconsistencies

Different severities
Different age at onset
Heterogeneity in response
Different triggers

Question 5

genes responsible for asthma?

Answer 5

ADAM33

ORMDL3

Question 6

what is the pathophysiological cause of asthma?

Answer 6

epithelial abnormality

Question 7

what disease is asthma associated with?

Answer 7

Eczema/asthma/etc
Allergy

allergy then will fuel the asthma

Question 8

epidemiology of asthma?

Answer 8

1.1 million UK children
110, 000 in Scotland
5% of UK children on inhaled steroids!

Question 9

why has there been an increase in asthma over the years?

Answer 9

Proven: westernisation

note proven:
Hygiene hypothesis
Dietary hypothesis

Breast feeding
Late weaning

Allergen
Ante- and post-natal

Smoking

Question 10

Diagnostic tests in asthma?

Answer 10

1. Spirometry
2. BDR
3. FeNO
4. Peak flow

not that helpful
Tests not reliable in <5s

Question 11

differential of a wheeze?

Answer 11

rattle sound (NOT WHEEZE)- bronchitis

stridor- croup

WHISTLE- WHEEZE

Question 12

presentation of asthma?

Answer 12

wheeze
SOB at rest- cooking in of ribs

dry cough-nocturnal
exertional

 Parental Hx asthma
Personal history
Eczema
Hayfever
Food allergies

Question 13

How to deffo know they have asthma?

Answer 13

asthma symptoms

• give ICS (brown inhaler) for 2 months (only works after 2)
• then stop- if symptoms go away -not asthma, it was a false positive

if asthma returns- it is asthma

Question 14

ideally to diagnose asthma you need:

Answer 14

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

Question 15

pro’s and cons of ICS?

Answer 15

cons:
Cost
Hassle
0.5-1cm loss in height
Oral thrush

pros:
Helps diagnosis
If symptoms respond
Improves QoL
Reduces risk of attacks

Question 16

When is it not asthma?- in relation to age

Answer 16

Under 18 months, most likely infection

Over 5 years, most likely asthma

BUT if it sounds like asthma and responds to asthma it is asthma regardless of age!

Question 17

ddx of asthma if onset under 5?

Answer 17

Bronchitis
Congenital
CF
PCD
Foreign body

Question 18

ddx if onset over 5?

Answer 18

Dysfunctional breathing
Vocal cord dysfunction
Habitual cough
Pertussis

Question 19

asthma vs VIW (viral induced wheeze- wheeze on excretion, wheeze on cat)

Answer 19

NOT separate conditions
Preschool children (99%)
Different shades of the same colour
The child does not care what u call it!
Should be treated

Question 20

approach to a pre-school cough?

Answer 20

-associated wheeze- go down wheeze algorthm

dry cough- watch and see

If it is moist cough and have red flags
(age<6mo or >4 y, no resolution, episodes of SOB, other condition
†Pertussis, habit cough, tracheomalacia, previous pneumonia, CF)
they have bronchiectasis !

moist cough and no red flags- Bacterial bronchitis