paediatric respiratory - asthma Flashcards
solution to asthma
- no wheeze no asthma
- tests may help decision
- if QoL affected confirm diagnosis with trial of ICS, QoL not affected watch and see
no wheeze
no asthma
what is asthma key features
wheeze
variability
respond to treatment
inconsistencies of asthma
- ‘transient’ vs persistent
- different severities
- different age at onset
- heterogeneity in response
- different triggers
asthma syndromes
infant onset childhood onset adult onset excertional asthma occupational asthma
what causes asthma? what we know
1/host response to environment
2/infection important
3/physiology abnormal before symptoms
4/it is a syndrome
what causes asthma
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
deciding when is it asthma
all in history
examination unhelpful
no diagnostic test in kids
tests can be useful for excluding things
asthma diagnosing in children: NICE
- spirometry
- broncho-dilatory response
- exhaled nitric oxide
- peak flow
what is asthma characterised by
wheeze
cough
episodes SOB
SOB at rest
<30% lung function - signif resp difficulty
asthma cough
dry
at night
exertional
asthma treatment
ICS for 2 months
ideal diagnostic criteria for asthma
wheeze (with and without URTI)
SOB at rest
parental asthma
responds to treatment
differential diagnoses for ‘asthma’
under 5
- congenital
- CF
- PCD
- bronchitis
- foreign body
5+
- dysfunctional breathing
- vocal cord dysfunction
- habitual cough
- pertussis
goals of asthma treatment
- minimal symptoms during day and night
- minimal need for reliever medication (<2dys/wk)
- no attacks (exacerbations)
- no limitation of physical activity
how to measure asthma control?
SANE
- short acting beta agonist/week
- absence school/nursery
- nocturnal symptoms/week
- excertional symptoms/week
step up step down approach to asthma management
start on low dose ICS
review after 2mo
- no change easier than stepping down
- need an inhaler holiday (easter)
classes of asthma medications for kids
- short acting beta agonists (blue)
- ICS - standard preventer
long acting beta agonist
leukotreine receptor antagonist
theophyllines
oral steroids
adverse effects of ICS
final adult height reduce by 0.5/1cm
oral candidiasis (if don't brush teeth) adrenocortical suppression partic with fluticasone
add on preventer - long acting beta agonist
do not use without ICS
use as fixed dose inhaler
asthma treatment delivery systems
MDI/spacer
dry powder device
dry powder devicers
under 8s cannot use them
achieive 20% lung deposition
using a spacer
shake MDI inhaler beween puffs
wash spacers each month - reduces static charge
MDI spacer vs nebuliser
quieter quicker valve mechanism dont break down portable cheaper
non-medical interventions for asthma
stop tobacco smoke exposure
remove environmental triggers - cat/dog
how to choose which management plan for acute asthma
resp rate work of breathing HR O2 sats ability to complete sentences confusion air entry
acute asthma management: mild
SABA via spacer
SABA via spacer + prednisolone
acute asthma management: moderate
SABA via neb + pred
SABA + ipra via neb + pred
acute asthma management: severe
IV salbutamol IV aminophylline IV magnesium IV hydrocortisone intubate and ventilate
asthma management - steroids chronic vs acute
chronic/maintenance treatment = inhaled steroids (not oral)
acute treatment = oral steroids (not inhaled steroids)
steps chronic asthma Mx
- ICS, if <5 LTRA
- add LABA
- inc dose ICS or trial LTRA
