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Respiratory 2 > Paediatric Asthma > Flashcards

Paediatric Asthma Flashcards

1
Q

Define asthma

A

An inflammatory condition marked by reversible airway obstruction. Patient will present with coughing, wheezing and shortness of breath.

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2
Q

How do the bronchi change in an asthmatic attack?

A

The smooth muscle becomes thick and full of mucus resulting narrowing of the airway.

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3
Q

What effect do eosinophils have on the basement membrane?

A

Eosinophils infiltrate the basement membrane and cause release of inflammatory mediators such as cytokines, chemokines and lipid mediators.

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4
Q

1 in 15 people have asthma and it is the commonest chronic condition in children.

A

1 in 15 people have asthma and it is the commonest chronic condition in children.

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5
Q

Children with eczema are twice as likely to have asthma, what is the link?

A

Gaps between epithelia where there should be tight junctions. This allows pathogens to penetrate the epithelium causing the problems of eczema and asthma.

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6
Q

TH0

A

Undifferentiated T cell.

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7
Q

What T cell is thought to initiate the asthmatic response?

A

TH2

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8
Q

What T cell is thought to perpetuate the asthmatic response?

A

TH17

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9
Q

How do allergic reactions initiate asthma?

A

Alarmins are released which activate antigen presenting cells. The APC cause TH0 to differentiate into TH2.

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10
Q

Which T cell is elevated in the blood in children with paediatric asthma?

A

TH2

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11
Q

Through what two pathways do TH2 cells cause asthma?

A

TH2 cells cause release of Eosinophils in one pathways and release of B cells in another.

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12
Q

How do TH2 cells cause eosinophil release?

A

IL5

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13
Q

What are the three phenotypes of preschool wheeze?

A

Transient early wheezers
Non-atopic wheezers
IgE wheeze / asthma

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14
Q

Explain transient early wheezers.

A

Transient early wheezers are commonly born with small airways at birth (this is associated with the mother smoking during pregnancy). Symptoms disappear with age.

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15
Q

Atopy refers to what?

A

Atopy refers to allergy, thus non-atopic means unrelated to an allergic reaction.

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16
Q

BDR

A

Bronchodilator responsiveness (BDR) is widely considered to be a key diagnostic tool for asthma, and is used to differentiate asthma from chronic obstructive pulmonary disease (COPD).

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17
Q

BHR

A

Bronchial hyperresponsiveness (BHR) is defined as excessive bronchial narrowing and manifests itself as an exaggerated bronchoconstrictor response of the airways to various inhaled stimuli.

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18
Q

Non-atopic wheezers present with wheezing around what age?

A

Age 3

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19
Q

Explain non-atopic wheezing.

A

Wheezing in response to viral infections - thought to increase chance of developing asthma later in life.

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20
Q

Explain IgE wheezing.

A

Occurs when child is sensitised to allergens.

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21
Q

Severe asthma increases risk of developing what other condition?

A

COPD

22
Q

Obese non-eosinophilic asthma is seen in what patient group?

A

Obese middle aged women.

23
Q

Why is obese non-eosinophilic asthma hard to treat?

A

The majority of asthma treatment revolves around managing inflammation.

24
Q

What is the main short acting bronchodilator?

A

Salbutamol

25
Q

Salbutamol acts how?

A

Salbutamol binds to beta2 adrenergic receptors causing release of CAMP. This causes relaxation of airway smooth muscle cells.

26
Q

Salmeterol

A

Salmeterol is a long-acting β2 adrenergic receptor agonist (preventer). Used in the prevention of asthma and maintenance of COPD.

27
Q

What medication is prescribed to manage asthma and how do they work?

A

Corticosteroids - inhibit histones reducing inflammation and stimulate anti-inflammatory genes and proteins.

28
Q

LTRA’s

A

Leukotriene receptor antagonists

29
Q

What do leukotriene receptor antagonists do?

A

They may also be referred to as anti-inflammatory bronchoconstriction preventors. LTRAs work by blocking a chemical reaction that can lead to inflammation in the airways.

30
Q

When are leukotriene receptor antagonists used?

A

When corticosteroid treatment is not possible or effective.

31
Q

What are the risk factors for paediatric asthma?

A

Mother smoking whilst pregnant
Mother stressed / anxious whilst pregnant
Mother inhaling pollution whilst pregnant
Obesity

32
Q

What can reduce the risk of paediatric asthma?

A

Breastfeeding

33
Q

What are the risk factors of an asthmatic attack?

A 
Parent smoking
Pollution
Obesity
Allergens
Stress
34
Q

What are the effects on the lungs of the fetus if the mother smokes in pregnancy?

A

Due to toxins, placental insufficiency and free radicals, there may be growth restriction, impaired airway development, thickening of the basement membrane.

This leads to 1.8 times increased risk of developing asthma, reduced response to bronchodilators, and increased fixed airway obstruction.

35
Q

What is the main allergic driver in paediatric asthma?

A

House dust mites (worst at night) - found on pillow and bed sheets.

36
Q

What are the essential symptoms of asthma?

A

Coughing and wheezing.

37
Q

How is Nitrous oxide affected in asthma?

A

NO concentrations increase with inflammation.

38
Q

Is asthma usually atopic or non-atopic in children?

A

Atopic

39
Q

Atopic asthma

A

Atopic asthma is triggered by a variety of environmental agents, including dust, pollens, foods and animal danders, for example, faecal pellets from house dust mites. There is often a family history of asthma, hay fever or atopic eczema.

40
Q

Acute Asthma is characterised by what?

A

— Bronchial inflammation with prominent numbers of eosinophils, lymphocytes and plasma cells
— Mucous plugging of bronchi
— Bronchial obstruction with distal overinflation or atelectasis or collapse
— Bronchial epithelial shedding and subsequent regeneration.

41
Q

Chronic asthma is characterised by what?

A

— Mucous gland hypertrophy
— Development of mucosa-associated lymphoid tissue
— Bronchial wall smooth muscle hypertrophy and fibrosis
— thickening of bronchial basement membrane.

42
Q

How is rhinosinusitis linked to asthma?

A

Both follow a similar disease process regarding eosinophils.

43
Q

Explain how parasympathetic innervation causes asthma.

A

Parasympathetic nerves cause bronchoconstriction and mucus secretion through M3 receptors.

44
Q

Explain the sympathetic innervation to the lungs.

A

Sympathetic nerves innervate blood vessels and glands, but not airway smooth muscle.

45
Q

Allergy

A

• Allergy – a hypersensitivity reaction initiated by specific immunological mechanisms. This can be IgE mediated (e.g. peanut allergy) or non-IgE mediated (e.g. coeliac disease).

46
Q

Atopy

A

• Atopy – a personal and/or familial tendency to produce IgE antibodies in response to ordinary exposures to potential allergens, usually proteins. Strongly associated with asthma, allergic rhinitis and conjunctivitis, eczema and food allergy.

47
Q

How do allergic disorders overlap?

A

• Rhinitis and conjunctivitis may precede the development of asthma. Allergic disorders often overlap. Many children with food allergy have eczema and up to 80% of children with asthma have rhinitis.

48
Q

Allergic march

A

The presence of eczema or food allergy in infancy is predictive of asthma and allergic rhinitis in later life. The progression is referred to as the ‘allergic march’.

49
Q

Urticaria

A

Also known as hives, is an outbreak of swollen, pale red bumps or plaques (wheals) on the skin that appear suddenly – either as a result of the body’s reaction to certain allergens, or for unknown reasons. Hives usually cause itching, but may also burn or sting.

50
Q

What are the symptoms of rhinitis?

A

Symptoms of allergic rhinitis include itching, sneezing, runny nose, stuffiness, and itchy, watery eyes. People may have headaches and swollen eyelids and also may cough and wheeze.

51
Q

Outline how asthma is managed.

A

Allergen avoidance, bronchodilators (beta agonists and antimuscarinics) inhaled corticosteroids and oral cortocosteriods, and anti-leukotrienes.

Respiratory 2 (22 decks)

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