paediatric respiratory - asthma Flashcards

1
Q

solution to asthma

A
  1. no wheeze no asthma
  2. tests may help decision
  3. if QoL affected confirm diagnosis with trial of ICS, QoL not affected watch and see
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2
Q

no wheeze

A

no asthma

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3
Q

what is asthma key features

A

wheeze
variability
respond to treatment

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4
Q

inconsistencies of asthma

A
  • ‘transient’ vs persistent
  • different severities
  • different age at onset
  • heterogeneity in response
  • different triggers
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5
Q

asthma syndromes

A
infant onset
childhood onset
adult onset
excertional asthma 
occupational asthma
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6
Q

what causes asthma? what we know

A

1/host response to environment
2/infection important
3/physiology abnormal before symptoms
4/it is a syndrome

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7
Q

what causes asthma

A

genes
interact with environment
epigenetics

primary epithelial abnormality (skin/airway/gut) results in eczema, asthma etc or allergy (which fuels asthma)

genes load gun and environment pulls tigger

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8
Q

deciding when is it asthma

A

all in history
examination unhelpful
no diagnostic test in kids
tests can be useful for excluding things

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9
Q

asthma diagnosing in children: NICE

A
  1. spirometry
  2. broncho-dilatory response
  3. exhaled nitric oxide
  4. peak flow
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10
Q

what is asthma characterised by

A

wheeze
cough
episodes SOB

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11
Q

SOB at rest

A

<30% lung function - signif resp difficulty

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12
Q

asthma cough

A

dry
at night
exertional

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13
Q

asthma treatment

A

ICS for 2 months

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14
Q

ideal diagnostic criteria for asthma

A

wheeze (with and without URTI)
SOB at rest
parental asthma
responds to treatment

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15
Q

differential diagnoses for ‘asthma’

A

under 5

  • congenital
  • CF
  • PCD
  • bronchitis
  • foreign body

5+

  • dysfunctional breathing
  • vocal cord dysfunction
  • habitual cough
  • pertussis
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16
Q

goals of asthma treatment

A
  • minimal symptoms during day and night
  • minimal need for reliever medication (<2dys/wk)
  • no attacks (exacerbations)
  • no limitation of physical activity
17
Q

how to measure asthma control?

A

SANE

  • short acting beta agonist/week
  • absence school/nursery
  • nocturnal symptoms/week
  • excertional symptoms/week
18
Q

step up step down approach to asthma management

A

start on low dose ICS

review after 2mo

  • no change easier than stepping down
  • need an inhaler holiday (easter)
19
Q

classes of asthma medications for kids

A
  • short acting beta agonists (blue)
  • ICS - standard preventer

long acting beta agonist
leukotreine receptor antagonist
theophyllines
oral steroids

20
Q

adverse effects of ICS

A

final adult height reduce by 0.5/1cm

oral candidiasis (if don't brush teeth)
adrenocortical suppression partic with fluticasone
21
Q

add on preventer - long acting beta agonist

A

do not use without ICS

use as fixed dose inhaler

22
Q

asthma treatment delivery systems

A

MDI/spacer

dry powder device

23
Q

dry powder devicers

A

under 8s cannot use them

achieive 20% lung deposition

24
Q

using a spacer

A

shake MDI inhaler beween puffs

wash spacers each month - reduces static charge

25
MDI spacer vs nebuliser
``` quieter quicker valve mechanism dont break down portable cheaper ```
26
non-medical interventions for asthma
stop tobacco smoke exposure | remove environmental triggers - cat/dog
27
how to choose which management plan for acute asthma
``` resp rate work of breathing HR O2 sats ability to complete sentences confusion air entry ```
28
acute asthma management: mild
SABA via spacer SABA via spacer + prednisolone
29
acute asthma management: moderate
SABA via neb + pred SABA + ipra via neb + pred
30
acute asthma management: severe
``` IV salbutamol IV aminophylline IV magnesium IV hydrocortisone intubate and ventilate ```
31
asthma management - steroids chronic vs acute
chronic/maintenance treatment = inhaled steroids (not oral) acute treatment = oral steroids (not inhaled steroids)
32
steps chronic asthma Mx
1. ICS, if <5 LTRA 2. add LABA 3. inc dose ICS or trial LTRA