Paediatrics 2 Flashcards
Give some causes of wheeze in a child
- Persistent infantile wheeze (small airways / smoking / viruses)
- Viral episodic wheeze (no interval symptoms / triggered by infection)
- Asthma (multiple trigger wheeze) -> persistent symptoms / FHx / atopic
- Other
Describe the presentation of ‘viral episodic wheeze’.
- No interval symptoms
- No excess of atopy
- Likely to improve with age
- No benefit from regular inhaled steroids
- Use bronchodilators
Describe the management of acute asthma
- Oxygen, if needed
- B-agonist
- Prednisolone 1mg/kg
- IV salbutamol bolus
- Aminophylline / MgSO4 / Salbutamol infusion
Treatment approaches to asthma include preventer and reliever inhalers. What class of drugs are the preventers, and give some examples.
Preventers = inhaled steroids
- Beclomethasone
- Budesonide
- Fluticasone
Treatment approaches to asthma include preventer and reliever inhalers. What class of drugs are the relievers, and give some examples.
B2 agonists eg.
- Salbutamol
- Terbutaline
- Ipratropium Bromide
Preventer and reliever inhalers are used to manage asthma. List 5 Add-on therapies which may be used in adjunct to the preventers + relievers.
- Long acting B2 agonists
eg. Salmeterol, Formoterol - Leukotriene receptor antagonists eg. Montelukast
- Theophyllines
- Omalizumab (Anti-IgE)
- Protect (High IgE)
On choosing a preventer inhaler for an asthmatic child, what considerations should you make?
What class of drugs are used as preventative medication in asthma?
- Lowest effective dose
- Minimise oral deposition
- Minimise GI absorption
STEROIDS!
On choosing a reliever inhaler for an asthmatic child, what considerations should you make?
What class of drugs are used as reliever medication in asthma?
- Age-appropriate device
- Easy to use
- Portable
- Dosage not critical
Drug class: B2-agonists.
A child has mild, intermittent asthma. What’s the first line management? (Step 1)
- Environment
- Inhaled short acting B2 agonist as required eg. Salbutamol
What is meant by ‘regular preventer therapy’ with regards to asthma control in a child? (Step 2)
Inhaled steroid eg. Beclametasone
200 - 400mcg / day
If regular preventer therapy fails to control a child’s asthma, what therapeutic option is recommended? (Step 3)
Add-on therapy:
- Add LABA eg. Salmeterol
- Assess control of asthma (is there a response to LABA)?
If a child has persistent poor control due to asthma, what therapeutic management can you recommend? (Step 4)
Increase inhaled steroid up to 800 mcg / day
eg. Beclametasone
If a child’s asthma is so poorly controlled that they are continuously / frequently using oral steroids, what action should you take?
- Refer to respiratory paediatrician
- Use daily steroid tablet in lowest dose providing adequate control
- Maintain high dose inhaled steroid at 800 mcg / day
An asthmatic child does not respond to treatment. Give 5 reasons why this might occur.
- Adherence (compliance)
- Bad disease
- Choice of drugs / devices
- Diagnosis
- Environment
What are the possible side effects of inhaled steroids (when used in the management of asthma)?
- May suppress the adrenals
- Might cause brief slowing of growth
- Oral thrush -> educate patient!
Give some examples of upper respiratory tract infections in children.
- Rhinitis
- Otitis media
- Tonsilitis
- Laryngitis
Give some examples of lower respiratory tract infections in children.
- Croup
- Epiglottitis
- Bronchiolitis
- Pneumonia
Acute stridor is seen in Croup. What is the causative organism of croup?
Viral -> Usually Parainfluenza
Describe the signs + symptoms seen in a child with croup.
- Worse at night
- Barking, seal-like cough
- Stridor
- Recession
Croup is usually caused by parainfluenza. Describe the course of the disease in children.
- Self limiting
- Spring / Autumn
A child in A+E is diagnosed with Croup. What medication should you give them?
Steroids!
What is the causative organism of acute epiglottis?
- Haemophilus influenza B
=> causes a severe, acute illness
List 2 diseases that might be caused by meningococcus.
- Septicaemia
- Meningitis
List 3 diseases caused by Haemophilus influenza B.
- Epiglottitis
- Meningitis
- Pneumonia