Paediatric Asthma Flashcards
What is the one major thing to remember?
No wheeze
No asthma
What is the biggest trigger for asthma?
Common cold
What should you do is you suspect asthma?
Try an asthma treatment and see if there is improvement
What kind of condition is asthma?
Chronic
What is important about defining asthma?
It cannot really be defined.
It is more a concept
Other diagnoses must be excluded
It varies over time
What is asthma no longer?
A diagnosis of exclusion
What are the key words associated with asthma?
- Wheeze
- Variability
- Respond to treatment
What similarities is there between asthma in children and asthma in adults?
- Symptoms
- Common
- Same triggers
- Same treatment
- Same pathology
How does asthma differ between adults and children?
- In children it is more common in boys and in adults it is more common in adults
- Severity
- Occupational asthma is uncommon in children
What is the epidemiology of asthma in children?
- 1 million UK children
- 100,000 Scottish children
- 5% of UK children on inhaled steroids
What explains the similarities between paediatric and adult asthma?
Final common pathway
What are the multiple hits required for asthma?
- Genes
- Inherently abnormal lungs
- Early onset atopy
- Later exposures
What later exposures can affect asthma?
- Rhinovirus
- Exercise
- Smoking
What inconsistences exist?
- Transient vs persistent
- Different severities
- Different age at onset
- Heterogeneity in response
- Different triggers
What is critical to making an asthma diagnoses?
Taking a history
Why is examination usually unhelpful?
Unlikely to be wheezing at consultation due to the episodic nature of asthma
Why is there no asthma test?
- Peak flow random number generator
- Allergy tests irrelevant
- Spirometry lacks specificity
- Exhaled nitric oxide unproven
What does not exist in childhood asthma
Cough variant asthma
What is not uncommon in childhood asthma?
Cough predominant asthma
What is the mechanism for wheeze in asthma?
- Bronchoconstriction
- Airway wall thickening
- Luminal secretions
Why are children’s airways more likely to be musical?
They are smaller
What is commonly reported as wheeze?
- Rattle
- Stertor
- Stridor
What is a sign or shortness of breath in asthma?
Sucking in of ribs with wheeze
What is a cough related to asthma like?
- Dry
- Nocturnal
- Exertional
What can trigger asthma?
- URTI
- Exercise
- Allergen
- Cold air
- Other such as emotion and menstruation
Why does atopy not cause asthma?
They are secondary to the same process and URTI is the primary precipitant
What personal history is common in asthmatics?
- Eczema
- Hay fever
- Food allergies
What has asthma and responds to asthma treatment?
Asthma
What is the treatment for asthma?
Inhaled Corticosteroids for 2 months
What is the ideal checklist for someone with asthma?
-Wheeze and shortness of breath at rest
-Multitrigger
-Sinusoidal
Atopy
-Parental asthma
-Responds to treatment
What is often the differential diagnosis of asthma?
- Viral induced wheeze
- Foreign body
- Cystic Fibrosis
- Immune deficiency
- Ciliary dyskinesia
- Tracheo-bronchomalacia
- Aspiration
- Gastro-oesophageal reflux
What is condition is said to be a different shade of asthma??
Viral induced wheeze
What is infrequent episodic wheeze with a cold treated with?
Salbutamol
When is a wheeze asthma?
A genuine wheeze which responds to treatment
When is it unlikely to be asthma?
In a child under 18 months it is more likely to be infection
What can an isolated cough be due to?
- Bronchitis (2-3 year old, wet cough)
- Pertussis (any age, fits, vomit, haematoma)
- Habitual cough (8-12 year old, single loud cough
- Trachheomalacia (life long loud cough)
- Small print (CF, FB, DI, PCD)
How does bronchitis present?
- Loose rattly cough
- Noisy breathing
- Post-tussive vomit
- Chest free of wheeze/creps
- Child is VERY well but parents are worried
What is the mechanism of bacterial bronchitis?
- Disturbed mucocitliary clearance
- RSV, adenovirus, rhinovirus
- Haemophilus culture medium
- 4+ week recovery
- Infection secondary
What is the natural history of bacterial b
- Following URTI
- Lasts 4 weeks
- 60-80% respond
- First Winter bad
- Second Winter better
- Third Winter fine
- Pneumococcus/ H flu
Why must there me a decision as the whether to treat bacterial bronchitis?
- No treatment= self-limiting
- Treatment= risk of diarrhoea, effect on quality of life
What is associated with pertussis?
Vomiting, colour change, petechiae, coughing fits
Why is pertussis common?
Vaccination only reduces risk
When is a preschool cough bacterial bronchitis?
- No associated wheeze
- Moist cough
- Responds to antibiotics
What is important to remember with asthmas?
- No wheeze, no asthma
- No asthma test
- Confirm the diagnosis with trial of ICS
- No lower age limit for diagnosing asthma
