Respiratory Flashcards
What is the incidence of asthma in children?
Why is Dx difficult?
Affects 15-20% children
Approx 50% all children wheezy unto 3y/o
What are the 2 types of wheezing and how are they different?
Transient early:
Grow out of + due to resp infection
Due to inflamm/narrowing of small airway
RF - mum smoking
Persistent recurrent:
Continues into school aged + due to common inhalant allergens (IgE - mediated)
Persistent symptoms + reduced lung func
RF - allergies (≥1 = atopic)
What are some features of asthma that differentiate it from viral wheeze? (5)
Interval symptoms b/wn acute exacerbations Symptoms worse at night/early morn Symptoms w. trigger (e.g. pets) \+ve response to therapy PMH/FH
What would be seen O/E in asthma (not in acute exac)? (3)
What 3 signs may be seen in long-term?
Harrison sulci
Other allergic disorders (eczema, rhinitis)
Growth normal
Hyperinflation
Generalised expiratory wheeze
Prolonged expiratory phase
What 3 signs would indicate chronic infection rather than asthma? (CF/bronchiectasis)
Clubbing
Wet productive cough
Poor growth
When are Ix done for asthma?
What Ix can be done (3)
Only to exclude other conditions (asthma is clinical Dx)
Skin prick test
CXR
PEFR
What would PEFR show in asthma (2)
Only in >5yrs
Shows diurnal/daily variations (lower in morn)
10-15% improvement in PEFR with treatment
What 5 other common conditions can mimic asthma?
Viral-induced wheeze Bronchiolitis Reflux CF Croup
What incidence/age group does viral induced wheeze occur in?
50% of U3s
More commonly boys
Grow out of by 5 (airways bigger)
What features must be assessed/looked for in acute asthma exacerbation? (12)
Wheeze Tachypnoea (>50 2-5s; >30 5+s) Tachycardia (>150; >120) Recession O2 sats (92%) PEFR
Severe:
Accessory mm
Pulsus paradoxus
Too breathless to talk/feed
Life-threatening:
Cyanosis
Lethary/drowsiness
Silent chest
What O2 sats / PEFR would be seen in mild acute exacerbation of asthma?
How is it managed (3)
Sats > 92%
PEFR > 50%
SABA (via spacer) - 2-4 puffs (+2 /2mins and up to 10)
Oral prednisolone
Reassess within 1hr
What O2 sats / PEFD in severe asthma attack?
How managed? (4)
Sats < 92%
PEFR < 50%
O2
SABA 10 puffs / 20-30mins - spacer/neb
Oral prednisolone / IV hydrocortisone
If no response to steroid → Neb ipratropium bromide
What O2 sats / PEFR in life-threatening asthma attack?
How managed? (6)
Sats <92%
PEFR < 33%
O2 Neb B2-agonists / 20-30mins Neb ipratropium bromide IV hydrocortisone Senior review/PICU Oral prednisolone upto 3d
List the different types of drugs used in asthma (8) + how each works
B2-agonists - B2-Rs
Anticholinergic bronchodilators (ipra) - via sympathetic
Inhaled steroids - prevent inflame prots/ reduce IgE response
LABAs
Methylxanthines (theophylline) - relax bronchiole SM
Oral steroids
Leukotriene inhibitors (stops leukotriene bronchoconstricting)
Anti-IgE (omalizumab)
Describe the Asthma management guideline steps for children 5-12? (5)
How is it different for U5s?
- SABA prn
- Steroid (inhaled)
- LABA (± increase steroid / ± leukotriene antag / ± theophylline)
- Increase inhaled steroid
- Oral steroids
- SABA prn
- Steroid / leukotriene antag
- leukotriene antag / Steroid
- Senior referral
What things can be done to advise parents on managing asthma? (4) (PERFO)
Provide PLAN (regime + technique)
EDUCATE on drugs (usage + compliance)
Educate on RED FLAGS (worsening cough / SOB/ wheeze; difficulty walk/talking/sleeping; less bronchodilator relief)
Provide ORAL steroid dose
What age does bronchiolitis present in
What is the incidence
What are the RFs
<18m (90% 1-9m)
20-30% (1/4) all infants every winter
RFs: Premature (/ventilated) CLD CF Congenital heart disease
How does Bronchiolitis present?
Coryzal symptoms → Dry cough + SOB → Feeding difficulties (worst at day 4)