RESP - Asthma

Question 1

What is the significance of a silent chest?

Answer 1

The airways are so tight that it is not possible for the child to move enough air through the airways to even create a wheeze. It is associated with reduced respiratory effort due to fatigue.

Question 2

How is a diagnosis made in kids below the age of 5?

Answer 2

Clinical judgement. A diagnosis is usually not made for kids below the age of 2.

Question 3

How is a diagnosis made in kids between the ages of 5-16?

Answer 3

1. Spirometry with Bronchodilator Reversibility Testing.

2. If (1) is normal or (1) shows obstructive picture with negative Bronchodilator Reversibility Testing, FeNO test.

Question 4

Management of Chronic Asthma : BTS Guidelines.

KIDS BELOW THE AGE OF 5 (4).

Answer 4

1. SABA as required.
2. Low-Dose ICS or LRA.
3. Low-Dose ICS and LRA.
4. Specialist Referral.

Question 5

Management of Chronic Asthma : BTS Guidelines.

KIDS BETWEEN 5-12 YEARS (7).

Answer 5

1. SABA as required.
2. Low-Dose ICS.
3. LABA e.g. Salmeterol (continued only if there is a good response).
4. Moderate-Dose ICS.
5. LRA or Oral Theophylline.
6. High-Dose ICS.
7. Specialist Referral.

Question 6

Management of Chronic Asthma : BTS Guidelines.

KIDS ABOVE THE AGE OF 12.

Answer 6

Same as adults.

Question 7

Management of Chronic Asthma : NICE Guidelines.

KIDS BELOW THE AGE OF 5 (4).

Answer 7

1. SABA.
2. 8 Week Trial of Moderate-Dose ICS (stop after 8 weeks and monitor symptoms to check if there might be an alternative diagnosis).
3. LRA.
4. Specialist Referral.

Question 8

Management of Chronic Asthma : NICE Guidelines.

KIDS BETWEEN 5-16 YEARS.

Answer 8

1. SABA.
2. Low-Dose ICS.
3. LRA.
4. LABA instead of LRA (stop LRA if it didn’t help).
5. SABA + MART (Low-Dose ICS).
6. SABA + MART (Moderate-Dose ICS).
7. SABA + MART (High-Dose ICS) or Theophylline Trial or Specialist Referral.

Question 9

Why can a patient be started on Step 2? (3)

Answer 9

1. Cannot be controlled on Step 1.
2. Newly-diagnosed Asthma with symptoms lasting more than 3 weeks.
3. Experiences night-time waking.

Question 10

Doses of ICS in Paediatrics.

Answer 10

Low - Less than 200mcg Budesonide.
Moderate - 200-400mcg Budesonide.
High - More than 400mcg Budesonide.

Question 11

Concern with Inhaled Steroids.

Answer 11

Evidence : Slightly reduces growth velocity and cause a small reduction in adult height up to 1cm when used long-term (dose-dependent).

Question 12

Management of Acute Asthma/Viral Induced Wheeze (4).

Answer 12

1. Supplementary Oxygen Therapy (if O2 Saturation is below 94% or obvious effort).
2. Bronchodilators e.g. Salbutamol, Ipratropium, Magnesium Sulphate.
3. Steroids e.g. Prednisolone (Oral), Hydrocortisone (IV).
4. Antibiotics (if bacterial cause) e.g. Amoxicillin, Erythromycin.

Question 13

Bronchodilator Therapy in Acute Asthma/Viral Induced Wheeze (4).

Answer 13

1. Inhaled/Nebulised Salbutamol (SABA).
2. Inhaled/Nebulised Ipratropium Bromide (SAMA).
3. IV Magnesium Sulphate.
4. IV Aminophylline.

Question 14

Referral to Hospital : Paediatric Acute Asthma/Viral Induced Wheeze.

Answer 14

1 puff of Salbutamol is given every 30-60 seconds, up to a maximum of 10 puffs. If symptoms are not controlled, refer.

Question 15

Management of Moderate/Severe Acute Asthma (8).

Answer 15

1. Salbutamol Inhaler.
2. Nebulised Salbutamol/Ipratropium Bromide.
   3 Oral Prednisolone (1mg/kg/day for 3 days).
3. IV Hydrocortisone.
4. IV Magnesium Sulphate.
5. IV Salbutamol.
6. IV Aminophylline.
7. Call Anaesthetist and ITU to intubate and ventilate.

Question 16

Reducing Regime in Acute Asthma.

Answer 16

1. 10 puffs 2 hourly.
2. 10 puffs 4 hourly.
3. 6 puffs 4 hourly (at this point, consider discharge).
4. 4 puffs 6 hourly (48 hours).
5. 2-4 puffs as required.

Question 17

Oral Prednisolone Therapy.

Answer 17

1. Continue for 3-5 days.

2. 20mg OD for 2-5 years; 30-40mg for 5+ years.