Paediatric Asthma

Question 1

What is the one major thing to remember?

Answer 1

No wheeze

No asthma

Question 2

What is the biggest trigger for asthma?

Answer 2

Common cold

Question 3

What should you do is you suspect asthma?

Answer 3

Try an asthma treatment and see if there is improvement

Question 4

What kind of condition is asthma?

Answer 4

Chronic

Question 5

What is important about defining asthma?

Answer 5

It cannot really be defined.
It is more a concept
Other diagnoses must be excluded
It varies over time

Question 6

What is asthma no longer?

Answer 6

A diagnosis of exclusion

Question 7

What are the key words associated with asthma?

Answer 7

• Wheeze
• Variability
• Respond to treatment

Question 8

What similarities is there between asthma in children and asthma in adults?

Answer 8

• Symptoms
• Common
• Same triggers
• Same treatment
• Same pathology

Question 9

How does asthma differ between adults and children?

Answer 9

• In children it is more common in boys and in adults it is more common in adults
• Severity
• Occupational asthma is uncommon in children

Question 10

What is the epidemiology of asthma in children?

Answer 10

• 1 million UK children
• 100,000 Scottish children
• 5% of UK children on inhaled steroids

Question 11

What explains the similarities between paediatric and adult asthma?

Answer 11

Final common pathway

Question 12

What are the multiple hits required for asthma?

Answer 12

• Genes
• Inherently abnormal lungs
• Early onset atopy
• Later exposures

Question 13

What later exposures can affect asthma?

Answer 13

• Rhinovirus
• Exercise
• Smoking

Question 14

What inconsistences exist?

Answer 14

• Transient vs persistent
• Different severities
• Different age at onset
• Heterogeneity in response
• Different triggers

Question 15

What is critical to making an asthma diagnoses?

Answer 15

Taking a history

Question 16

Why is examination usually unhelpful?

Answer 16

Unlikely to be wheezing at consultation due to the episodic nature of asthma

Question 17

Why is there no asthma test?

Answer 17

• Peak flow random number generator
• Allergy tests irrelevant
• Spirometry lacks specificity
• Exhaled nitric oxide unproven

Question 18

What does not exist in childhood asthma

Answer 18

Cough variant asthma

Question 19

What is not uncommon in childhood asthma?

Answer 19

Cough predominant asthma

Question 20

What is the mechanism for wheeze in asthma?

Answer 20

• Bronchoconstriction
• Airway wall thickening
• Luminal secretions

Question 21

Why are children’s airways more likely to be musical?

Answer 21

They are smaller

Question 22

What is commonly reported as wheeze?

Answer 22

• Rattle
• Stertor
• Stridor

Question 23

What is a sign or shortness of breath in asthma?

Answer 23

Sucking in of ribs with wheeze

Question 24

What is a cough related to asthma like?

Answer 24

• Dry
• Nocturnal
• Exertional

Question 25

What can trigger asthma?

Answer 25

- URTI - Exercise - Allergen - Cold air - Other such as emotion and menstruation

Question 26

Why does atopy not cause asthma?

Answer 26

They are secondary to the same process and URTI is the primary precipitant

Question 27

What personal history is common in asthmatics?

Answer 27

- Eczema - Hay fever - Food allergies

Question 28

What has asthma and responds to asthma treatment?

Answer 28

Asthma

Question 29

What is the treatment for asthma?

Answer 29

Inhaled Corticosteroids for 2 months

Question 30

What is the ideal checklist for someone with asthma?

Answer 30

-Wheeze and shortness of breath at rest -Multitrigger -Sinusoidal Atopy -Parental asthma -Responds to treatment

Question 31

What is often the differential diagnosis of asthma?

Answer 31

- Viral induced wheeze - Foreign body - Cystic Fibrosis - Immune deficiency - Ciliary dyskinesia - Tracheo-bronchomalacia - Aspiration - Gastro-oesophageal reflux

Question 32

What is condition is said to be a different shade of asthma??

Answer 32

Viral induced wheeze

Question 33

What is infrequent episodic wheeze with a cold treated with?

Answer 33

Salbutamol

Question 34

When is a wheeze asthma?

Answer 34

A genuine wheeze which responds to treatment

Question 35

When is it unlikely to be asthma?

Answer 35

In a child under 18 months it is more likely to be infection

Question 36

What can an isolated cough be due to?

Answer 36

- 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)

Question 37

How does bronchitis present?

Answer 37

- Loose rattly cough - Noisy breathing - Post-tussive vomit - Chest free of wheeze/creps - Child is VERY well but parents are worried

Question 38

What is the mechanism of bacterial bronchitis?

Answer 38

- Disturbed mucocitliary clearance - RSV, adenovirus, rhinovirus - Haemophilus culture medium - 4+ week recovery - Infection secondary

Question 39

What is the natural history of bacterial b

Answer 39

- Following URTI - Lasts 4 weeks - 60-80% respond - First Winter bad - Second Winter better - Third Winter fine - Pneumococcus/ H flu

Question 40

Why must there me a decision as the whether to treat bacterial bronchitis?

Answer 40

- No treatment= self-limiting | - Treatment= risk of diarrhoea, effect on quality of life

Question 41

What is associated with pertussis?

Answer 41

Vomiting, colour change, petechiae, coughing fits

Question 42

Why is pertussis common?

Answer 42

Vaccination only reduces risk

Question 43

When is a preschool cough bacterial bronchitis?

Answer 43

- No associated wheeze - Moist cough - Responds to antibiotics

Question 44

What is important to remember with asthmas?

Answer 44

- No wheeze, no asthma - No asthma test - Confirm the diagnosis with trial of ICS - No lower age limit for diagnosing asthma