L7 - Paediatric Asthma Flashcards
Asthma clinical characteristics
Characterised by recurrent episodes of wheeze, cough and breathlessness.
Inflammation of airways.
Bronchial hyper-reactivity
Risk of asthma will increase if…
- Positive family history of asthma and atopy
- Maternal smoking in pregnancy
- Early sensitisation to air borne allergens.
Atopy
Genetic tendency to develop allergic diseases such as:
- allergic rhinitis
- asthma
- atopic dermatitis (eczema)
How may you test for asthma?
Test Peak Flow
- repeat after administration of short acting beta 2 agonist.
What is an example of a first line preventative treatment for asthma?
Inhaled corticosteroid
Advantage of using an inhaler with a spacer
- Delivery of drug to lungs is optimised.
- Children must be shown how to use inhaler and have their technique checked.
Adverse environmental factors leading to asthma
- Contine levels (exposure of nicotine in tobacco)
- Exposure to household mould
- Allergy to pets
Co-morbidities associated with asthma
- Obesity
- rhinosinusitis (inflammation of sinuses and nasal cavity)
- food allergy
- Dysfunctional breathing
- exercise induced laryngeal obstruction
Signs of an asthma attack (6)
- Difficulty talking . walking
- Unable to feed
- Little relief with salbutamol
- Drop in peak flow
- Hard and fast breathing
- Coughing and wheezing a lot.
Describe an example of a personal action plan of a patient during an asthma attack
- 10 puffs of salbutamol
2. If symptoms persist then call ambulance
Episodic viral wheeze could be due to…
- Exercise
- Viral cold
- Exposure to allergens
- Cold air
Sarcoidosis
- Multi-system inflammatory disorder
- which most commonly involves the mediastinal lymph nodes and lungs
What is pulmonary langerhan cell histocytosis?
- Proliferation of Langerhan cells
- Occurs in response to cigarette smoke
Alveolar lipoproteinosis
Rare
Characterised by accumulation of eosinophillic material within alveoli.
Describe different types of lung tumour
Can either be:
1- Primary (most common, majority related to cigarette smoking)
2- Secondary
Common sites of metastases in lung cancer
- Lymph nodes
- Pleura
- Adrenal glands
- Bone
- Brain
Risk factors of lung cancer
- Cigarette smoking
- asbestos exposure
- uranium mining
- radon gas
- pulmonary fibrosis
Describe squamous cell carcinoma
Tumour usually central in location.
Frequency cavitate.
Recognised by presence of keratin.
Cavitation
Phenomenon where rapid changes in pressure in liquid lead to formation of small vapor filled cavities.
Describe an adenocarcinoma
what gives evidence towards an adenocarcinoma?
May be central or peripheral
Acinar or papillary glandular growth pattern.
Evidence of mucin production by cell.
Describe a large cell undifferentiated carcinoma?
These tumours are poorly differentiated.
Show no evidence of squamous or glandular differentiation
Small cell lung carcinomas arise in…
Central bronchus
Contrast Asthma with COPD
Reversibility of airway obstruction in asthma contrasts with COPD.
In COPD - obstruction is either not reversible or only partly reversible at best with a bronchodilator
Describe the pathophysiology of asthma
- Asthmatic’s have activated T cell with T-helper TH2 cells.
- TH2 cytokine released will attract other inflammatory granulocytes (eosinophils, Interleukin 5, granulocyte-macrophage colony)
- stimulating factor which causes esinophils to produce cysteinyl leukotrienes.
- Release granule protein that damages epithelium
