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paediatrics > paediatric respiratory - asthma > Flashcards

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
Q

MDI spacer vs nebuliser

A 
quieter
quicker
valve mechanism 
dont break down 
portable cheaper
26
Q

non-medical interventions for asthma

A

stop tobacco smoke exposure

remove environmental triggers - cat/dog

27
Q

how to choose which management plan for acute asthma

A 
resp rate
work of breathing 
HR
O2 sats
ability to complete sentences
confusion 
air entry
28
Q

acute asthma management: mild

A

SABA via spacer

SABA via spacer + prednisolone

29
Q

acute asthma management: moderate

A

SABA via neb + pred

SABA + ipra via neb + pred

30
Q

acute asthma management: severe

A 
IV salbutamol
IV aminophylline 
IV magnesium
IV hydrocortisone
intubate and ventilate
31
Q

asthma management - steroids chronic vs acute

A

chronic/maintenance treatment = inhaled steroids (not oral)

acute treatment = oral steroids (not inhaled steroids)

32
Q

steps chronic asthma Mx

A
  1. ICS, if <5 LTRA
  2. add LABA
  3. inc dose ICS or trial LTRA

paediatrics (68 decks)

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