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Final Notes > Paeds: Asthma HW > Flashcards

Paeds: Asthma HW Flashcards

1
Q

Definition

A

A reversible airway obstruction

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2
Q

Epi

A
  • 300 million people worldwide
  • Childhood: M>F
  • Post puberty: F>M
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3
Q

Cause

A
  1. Atopy and allergy
  2. Combination Genetic predisposition and environmental influences
  3. Other possibilities
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4
Q

Other causes

A
  1. Hygiene hypothesis: reduced infections in early life bias immune system towards allergic phenotype - Th2. T lymphocytes may differentiate into Th1 (fights virus/bacteria) or Th2 (allergic response)
  2. Warm, humid, centrally heated homes = multiplication of dust mites.
  3. Obesity - Asthma due to mechanical mechanisms e.g. GORD
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5
Q

Pathophysiology

A

Environmental factors and Genetic predisposition

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6
Q

Environmental factors and genetic predisposition leads to

A
  1. Bronchial inflammation
  2. Bronchial hyper-reactivity and trigger factors
  3. Oedema, bronchoconstriction, increase mucus production and smooth muscle hypertrophy
  4. Airways narrowing and obstruction
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7
Q

Symptoms

A

Cough
Wheeze
Breathlessness
Tight chest

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8
Q

Trigger factors for bronchial hyper-reactivity and trigger factors

A
  1. URTI
  2. Allergens
  3. Smoking (active/passive)
  4. Cold air
  5. Exercise
  6. Emotional upset/excitement
  7. Chemical irritants
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9
Q

Pathogenesis steps 1

A
  • Mast cell increase and degranulate
  • Th2 process driven
    3. Mediators released- Histamine and cysteinyl leukotrienes
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10
Q

Pathogenesis Step 2

A
  1. Eosinophils increase and degranulate
  2. Epithelium sheds and attracts more inflammatory cells
  3. Basement membrane thickens
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11
Q

Pathogenesis Step 3

A

Increase macrophages and increase lymphocytes

Nerves exposed and release factors that increase cytokines

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12
Q

Clinical Features/presentations

A
  1. Wheeze (recurrent episodes), Chest tightness, Breathlessness, Cough
  2. Diurnal pattern
  3. Nocturnal asthma
  4. ‘Cough-variant asthma’
  5. Medication related
  6. Occupational asthma
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13
Q

Diurnal pattern

A

symptoms/PEF worse in early morning

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14
Q

Nocturnal asthma

A

cough and wheeze disturbing sleep

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15
Q

Cough variant asthma

A

cough dominant symptoms

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16
Q

Medication related

A

Beta-blockers (may induce bronchospasm), aspirin (associated with rhinosinusitis, nasal polyps), other NSAIDS

17
Q

Occupational asthma

A

Considered if working age and symptoms improve during time away from work - increased risk: atopy and smokers.

18
Q

Mild asthma

A

Asymptomatic between exacerbations which occur during viral RTI or after exposure to allergens

19
Q

Persistent asthma

A

Pattern of chronic wheeze and breathlessness. Long standing obstruction causes pectus carinatum (pigeon chest) and/or Harrison’s sulcus.

20
Q

Diagnosis

A

Clinical history with demonstration of variable airflow obstruction.

21
Q

Investigations

A
  1. Pulmonary function tests
  2. Bronchial challenge test (AHR)
  3. Exercise test
  4. Radiological
  5. Measurement of allergic status
  6. ABGG’s
  7. Pulse ox
22
Q

Pulmonary function tests PEFR

A
  • Record PEFR after rising in morning and before retiring in evening
  • Diagnostic: >20% diurnal variation >3 days in a week for 2 weeks on PEF diary - amount of variability is some indication of disease severity.
23
Q

Pulmonary function tests Spirometry

A

Detects signs of obstructive airway disease - almost normal/ reduced VC, increased total lung and residual capacities

  1. Can trial corticosteroids - useful to see improvement in PEFR
  2. Diagnostic: FEV1 >15% improvement following administration of a bronchodilator/trial of corticoteroids.
24
Q

Bronchial challenge test (AHR)

A
  • Demonstrates airway hyper-reactivity - due to bronchoconstriction - increased concentrations of histamine/methacholine causes a reduction in FEV1 if asthmatic
  • Note: has a high -ve predictive value but +ve results may be seen in other conditions e.g. COPD, CF
25
Q

Exercise test

A
  • If asthmatic exercise should cause a reduction in PEF/ FEV1
  • diagnostic: FEV1>15% reduction after 6 mins of excercise
26
Q

Radiological

A

Generally unhelpful but may show alternative diagnosis

Acute asthma signs: Hyperinflation and ± lobar collapse

27
Q

Measurement of allergic status

A
  • Skin prick tests: Measurement of IgE to confirm sensitivity to specific agent
  • Atopic asthma: Increased sputum or peripheral blood eosinophil count and raised serum total IgE
28
Q

Occupational asthma diagnosis

A

Diagnosis difficult. Do two-hourly PEF recordings including time away from work. Bronchial provocation tests with suspected agent may be required.

29
Q

Management

A
  1. Medication

2. Patient educatoin

30
Q

Patient education

A
  • inhaler technique
  • Medication - when to use, what each does, frequency, dosage.
  • Use of PEF
  • Relationship between symptoms and inflammation and important key symptoms e.g. nocturnal waking
  • What to do if acute asthma attack
  • Avoidance of aggravating factors
  • Do not smoke
31
Q

Atopic disorders

A
  • Asthma
  • Eczema
  • Allergic rhinitis
  • Allergic conjunctivitis
  • Urticaria and angiooedema
  • Food and drug allergies
32
Q

Investigations for atopic diagnosis

A

+ve skin test to common allergens, eosinophilia and raised serum level of IgE

Final Notes (196 decks)

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