Pre_school_Wheeze_flashcards
How common is wheeze in pre-school children?
Wheeze is extremely common in pre-school children, with an estimated 25% of children having an episode of wheeze before 18 months.
What is one of the most common diagnoses made on paediatric wards related to wheeze?
Viral-induced wheeze is one of the most common diagnoses made on paediatric wards.
What are the two groups used to classify pre-school wheeze?
The two groups used to classify pre-school wheeze are episodic viral wheeze and multiple trigger wheeze.
What is episodic viral wheeze?
Episodic viral wheeze is when a child only wheezes during a viral upper respiratory tract infection (URTI) and is symptom-free between episodes.
What is multiple trigger wheeze?
Multiple trigger wheeze is when wheeze is triggered not only by viral URTIs but also by factors such as exercise, allergens, and cigarette smoke.
Is episodic viral wheeze associated with an increased risk of asthma in later life?
No, episodic viral wheeze is not associated with an increased risk of asthma in later life.
What should parents who are smokers be encouraged to do if their child has pre-school wheeze?
Parents who are smokers should be strongly encouraged to stop.
What is the first-line treatment for episodic viral wheeze?
First-line treatment for episodic viral wheeze is symptomatic treatment with short-acting beta 2 agonists (e.g., salbutamol) or anticholinergic via a spacer.
What is the next step in treatment if first-line treatment for episodic viral wheeze is not effective?
If first-line treatment is not effective, the next step is intermittent leukotriene receptor antagonist (montelukast), intermittent inhaled corticosteroids, or both.
Is there a role for oral prednisolone in children with episodic viral wheeze who do not require hospital treatment?
There is now thought to be little role for oral prednisolone in children with episodic viral wheeze who do not require hospital treatment.
What is the management for multiple trigger wheeze?
For multiple trigger wheeze, a trial of either inhaled corticosteroids or a leukotriene receptor antagonist (montelukast), typically for 4-8 weeks, is recommended.
summarise
Pre-school wheeze in children
Wheeze is extremely common in pre-school children, with an estimated 25% of children having an episode of wheeze before 18 months. Viral-induced wheeze is now one of the most common diagnoses made on paediatric wards. There is however ongoing debate regarding the classification of wheeze in this age group and the most appropriate management.
Over recent years, led by the European Respiratory Society Task Force, the favoured classification for pre-school wheeze is to divide children into one of two groups;
episodic viral wheeze: only wheezes when has a viral upper respiratory tract infection (URTI) and is symptom free inbetween episodes
multiple trigger wheeze: as well as viral URTIs, other factors appear to trigger the wheeze such as exercise, allergens and cigarette smoke
Episodic viral wheeze is not associated with an increased risk of asthma in later life although a proportion of children with multiple trigger wheeze will develop asthma.
Management
Parents who are smokers should be strongly encouraged to stop.
Episodic viral wheeze
treatment is symptomatic only
first-line is treatment with short acting beta 2 agonists (e.g. salbutamol) or anticholinergic via a spacer
next step is intermittent leukotriene receptor antagonist (montelukast), intermittent inhaled corticosteroids, or both
there is now thought to be little role for oral prednisolone in children who do not require hospital treatment
Multiple trigger wheeze
trial of either inhaled corticosteroids or a leukotriene receptor antagonist (montelukast), typically for 4-8 weeks
An 18-month-old boy is brought to the GP by his mother as she is concerned about his breathing. Three days ago he started with fever, cough and rhinorrhoea. For the past 24 hours his mother reports that he has been ‘wheezy’. On examination his temperature is 37.9ºC, heart rate 126/min, respiratory rate 42/min and a bilateral expiratory wheeze is noted. You prescribe a salbutamol inhaler along with a spacer. Two days later the mother represents noting the inhaler has made little difference to the wheeze. Clinical findings are similar, although his temperature today is 37.4ºC. What is the most appropriate next step in management?
Inhaled long-acting beta agonist
Oral prednisolone
Add in regular ipratropium bromide
Oral montelukast or inhaled corticosteroid
Oral amoxicillin
Oral montelukast or inhaled corticosteroid
This child is likely to have a viral-induced wheeze, also known as episodic viral wheeze. First-line treatment is short-acting bronchodilator therapy. If this is not successful then either oral montelukast or inhaled corticosteroids should be tried.
