Level 1 - Respiratory Flashcards
What is asthma?
- Chronic airway inflammation, bronchial hyper-reactivity and reversible airway obstruction
Pathology of asthma?
- mix of genetic predisposition, atopy and environmental triggers that cause:
o Bronchial inflammation
o Infiltration of neutrophils, eosinophils, mast cells, lymphocytes
o Bronchial hypersensitivity
o Airway narrowing
o Thicker, excessive mucous production
o. Reversibility
Epidemiology of asthma?
- Commonest childhood chronic illness
- 15-20% of children
- Males>females
Risk factors for asthma?
- Atopy (40% have FHx)
- Smoking
- Low birth weight/Premature birth
Triggers for asthma exacerbation?
- Allergens (house dust mite, pollen, pets, feathers, fur)
- Exercise
- Viruses
- Cold
- Smoke/Pollution
Symptoms of asthma?
- Cough o Recurrent, dry cough o Worse at night and with exercise (diurnal variation) - Wheeze o Expiratory noise due to airway narrowing o Prolonged expiration o Responds to bronchodilators - Shortness of breath o Limiting exercise, daily life - Stunted growth
Signs of asthma? When is it worse?
Signs (usually normal between exacerbations)
- Barrel-shaped chest
- Accessory muscle use
- Hyperinflated chest
- Harrisons sulcus
What symptoms are there in an acute asthma attack? How is it classified?
- Acute SOB, cough, wheeze, work of breathing
- Severity
o Mild – breathlessness, PEFR >50% of expected
o Severe – cannot complete sentances, RR >25, pulse >130bpm, PEFR <50% of expected
o Life-Threatening – ACHEST3392
DDx of asthma?
Bronchiolitis Pneumonia/TB Inhaled foreign body Croup Cystic Fibrosis
Investigations for children under 5?
- Treat symptoms based on observation and clinical judgement
- Review child regularly
- If still have symptoms at 5 years, carry out objective testing
When to perform investigations for asthma in children 5-16 years?
- Treat immediately if they are acutely unwell
- Perform objective tests for asthma if the equipment is available and testing will not compromise treatment of the acute episode
Give the objective investigations in asthma? Give the positive result values?
o Spirometry FEV1/FVC<70% of predicted o BDR test FEV1 improvement of >12% if positive Diagnosed if both spirometry and BDR positive o FeNO test If uncertain and negative spirometry and BDR 35ppb or more is positive test Refer if negative o PEFR variability 2-4 weeks If normal spirometry OR obstructive spirometry, negative BDR, positive FeNO >20% variability is positive
What happens if child unable to perform objective tests in asthma?
- Treat based on observation and clinical judgement
- Try doing the tests again every 6 to 12 months
What other investigations may be needed to rule out other DDx in asthma?
Chest X-Ray – if exclusion of pneumothorax is needed
Allergy tests – skin prick test
Sputum culture
General measures in asthma management?
Reduce exposure to triggers
Monitor disease
- Symptom and PEFR diary
- After starting or adjusting medicines for asthma, review the response to treatment in 4 to 8 weeks
Educate the family about good inhaler technique
When will you move up asthma ladder in chronic treatment?
3x SABA per week, woken
3 month usually
Step 1 in asthma treatment in children all ages?
- Inhaled short-acting B2 agonist (salbutamol, terbutaline, ipratropium bromide (infants/children))
Step 2 in asthma treatment in children under 5?
Add LTRA
Step 3 in asthma treatment in children under 5?
• Low dose ICS – 8-week trial
- If symptoms resolved then reoccurred within 4 weeks of stopping ICS – restart on low-dose ICS
- If symptoms resolved but reoccurred beyond 4 weeks of stopping ICS, repeat low-dose ICS
Step 4 in asthma treatment in children under 5?
•Refer to respiratory physician
Step 2 in asthma treatment in children aged 5-16?
• Add inhaled paediatric low dose ICS
Step 3 in asthma treatment in children aged 5-16?
• Add on LABA
Review 4-8 weeks
If no response, stop LABA and start LTRA
Step 4 in asthma treatment in children aged 5-16?
• Add LTRA
Step 5 in asthma treatment in children aged 5-16?
• Increase dose of ICS to paediatric moderate dose
Referral to paediatrician