Respi infx, Asthma Flashcards
What can be measured to assess airway inflammation in asthma
FeNO (fraction of exhaled nitric oxide)
During inflammation, increased NO released from epithelial cells of bronchial wall
What are some signs of asthma in a CXR
- hyperinflation
- increased bronchial markings
What should a health professional always do before stepping up on the BTS guidelines
- Check compliance
- Check inhaler technique
Signs of poorly controlled asthma
- Nocturnal and early morning symptoms
- Reduced exercise tolerance
- Symptoms more than 3 times a week
- Use if reliever more than 3 times a week
How quickly does a salbutamol inhaler work? How long does it last for?
Works within 5-10min.
Lasts for 4h.
What is the emergency dose of salbutamol in the case of an asthma attack?
If usual dose of beta-agonist does not relieve symptoms and symptoms worsening-give 10 puffs of inhaler (1 dose at a time).
What are the reasons for stepping up to inhaled corticosteroid treatment?
- Asthma attack in last 2 years requiring oral corticosteroids
- Using beta-agonist (salbutamol) 3 times a week or more
- Symptomatic 3 times a week or more
- Nocturnal symptoms
How long will it take for a patient to see a difference in his/her condition after starting on ICS?
Up to 2-4 weeks
side effects of salbutamol
Tachycardia, tremor, hyperactivity
What are the side effects of inhaled corticosteroids? What advice can you give to prevent these?
Oral thrush, hoarse voice. Rinse mouth after use or brush teeth to avoid side effects.
Should a child use his reliever or preventer inhaler first?
Use reliever first as it’s action is to the open airways and then the preventer can get to where it needs to work.
In what age group is bronchiolitis likely
Babies up to 2 years old
Signs of respiratory distress in babies
" Head bobbing " Nasal flaring " Tracheal tug " Accessory muscle use; chest retractions (sternal, subcostal, intercostal), see-saw breathing " Cyanosis " Apnoea
Until what age are babies preferential nose breathers
6 months
Respiratory causes of respiratory distress in infant
- bronchiolitis
- viral wheeze
- pneumonia
- pneumothorax
- pleural effusion
- foreign body
Cardiac causes of respiratory distress in infant
- herat failure
- severe anaemia
Generalised causes of respiratory distress in infant
- anaphylaxis
- metabolic acidosis
What breathing rate indicates severe respiratory distress in a child
Over 70 breaths per minute
Likely cause of wheezey chest in
<2y
2-4y
>4y
- <2y: bronchiolitis
- 2-4y: viral induced wheeze (treat like asthma)
- > 4Y: asthma
In asthma patients, when might a bolus of IV salbutamol be given
In severe asthma attack, where pt has not responded to initial inhaled therapy
After what age does a peak flow tend to be more accurate
After 7yo
Around how many puffs are in 1 salbutamol inhaler
Around 100 puffs
Should not need to change inhaler every month
Core symptoms to ask about in child’s respi history
- cough
- haemoptysis
- wheeze, stridor
- apnoeic episodes
- work of breathing
- colour (cyanosis)
3 Most common viruses in common cold
- Rhinovirus
- RSV
- Coronavirus
Most common causes of pneumonia in children:
Viruses
Bacteria
Viruses: RSV, Influenza A and B
Bacteria: Strep pneumonia
There are multiple tests to diagnose asthma.
Which are the most common?
- Spirometry
2. Fraction of exhaled nitric oxide (FeNO)
How do FeNO levels correspond with asthma
Increased inflammation -> increased NO released from epithelial cells of bronchial wall
Most common cause of croup
Parainfluenza virus
What causes the barking cough in croup
Tracheal oedema and collapse
In what age group does croup occur
6 months to 6 years
Most common viral cause of bronchiolitis
RSV
What might be heard on ausculation of a children with bronchiolitis
- wheeze
- fine-end inspiratory crackles
What features would indicate admission for bronchiolitis
- Apnoea
- Severe respiratory distress
- O2 sats <92% on air
- Feeding less than 50-75% of usual volume
What 2 investigations are always routine for bronchiolitis
- Oxygen saturations (pulse oximeter)
2. Nasal pharyngeal aspirate for RSV
Difference in presentation of pertussis in younger vs older children.
Which is more serious?
Older: persistent cough
Younger (more serious):
severe hypoxia, cerebral damage
Why do babies grunt
To increase end expiratory pressure
Signs of ACUTE SEVERE asthma
- SpO2
- PEF
appearance
(think of heart, chest)
ACUTE SEVERE
SpO2 <92%
PEF 33-50% best
To breathless to feed/ complete sentences
Tachycardia
Tachypnoea
Signs of LIFE THREATENING asthma
- SpO2
- PEF
appearance
(think of heart, chest)
LIFE THREATENING
SpO2 <92%
PEF <33% best
Silent chest
Hypotension
Confusion, exhaustion
Management of acute asthma
O SHIT ME
Oxygen** Salbutamol Hydrocortisone** Ipratropium** Theophylline MgSO4 (Escalate)
**=first line
On what day do bronchiolitis symptoms peak
Day 4-5
Main 2 complications of bronchiolitis
- Respiratory distress
2. Poor feeding
