Paeds - Asthma Management

Question 1

What are the hallmark signs for asthma in a history?

Answer 1

• Wheeze, cough or breathlessness (daily or seasonal variation or nocturnal cough)
• Triggers
• Personal or family hx of atopy

Question 2

What would auscultation of an asthmatic chest show?

Answer 2

Expiratory polyphonic wheeze

Question 3

What are the objective tests for asthma?

Answer 3

• Fractional exhaled nitric oxide (FeNO)
• Spirometry
• Peak flow variability

Question 4

What are skin prick or specific IgE tests used for in asthma?

Answer 4

To identify triggers after a formal diagnosis has been made

Question 5

How are children under 5 diagnosed with asthma?

Answer 5

Treat symptoms based on observations and clinical judgement and review on a regular basis, if they still have symptoms when they reach 5 years, carry out objective tests

Question 6

How should asthma be diagnosed in a child aged 5 when objective tests are unable to be performed?

Answer 6

• Continue to treat based on observation and clinical judgement
• Try doing the tests again every 6-12 months
• Consider referral for specialist assessment if you can’t perform objective tests and the child isn’t responding to treatment

Question 7

What are the objective tests for airway inflammation in asthma?

Answer 7

FeNO (aged 5-16) if there is diagnostic uncertainty and they have either:
- Normal spirometry or
- Obstructive spirometry with negative bronchodilator reversibility test

Question 8

What is a positive FeNO?

Answer 8

35ppb or more

Question 9

What are the lung function tests to offer in asthma?

Answer 9

• Spirometry
• Bronchodilator reversibility test if there’s an obstructive spirometry (FEV1/FVC ratio <70%)
• Peak expiratory flow variability (only if there is diagnostic uncertainty, a negative FeNO and normal spirometry or obstructive spirometry and a negative BDR)

Question 10

What are the positive results of the lung function tests?

Answer 10

• Spirometry: FEV1/FVC <70%
• BDR test: Improvement in FEV1 of 12% or more, together with an increase in volume of 200ml or more
• PEFR: >20% variability

Question 11

What are the diagnostic parameters for asthma in a child 5-16?

Answer 11

• Symptoms suggestive of asthma and
• FeNO 35ppb or more and positive PEFR or
• Obstructive spirometry and positive BDR test

Question 12

What results of the objective tests would warrant a child for referral for specialist assessment?

Answer 12

• Obstructive spirometry
• Negative bronchodilator reversibility and
• FeNO <34ppb

Question 13

What is the reliever therapy for children (5-16) with newly diagnosed asthma?

Answer 13

SABA, salbutamol 100 micrograms/ dose-metered inhaler or 100-200 micrograms (1-2 puffs) every 4-6 hours as required

Question 14

When should reliever therapy (SABA) alone be used in asthma?

Answer 14

For patients with an infrequent, short-lived wheeze