Respiratory - Asthma Flashcards
What is asthma?
- Chronic respiratory condition characterised by variability and reversibility
- Presents with wheeze, cough and SOB
- Multiple triggers
- Responds to asthma treatment
Give examples of asthma triggers.
- URTI
- Exercise
- Allergen
- Cold weather
What is the epidemiology of asthma?
- 1 million UK children
- 100, 000 in Scotland
- 5% of UK children on inhalers
What is the multiple hits theory of asthma?
- Genes
- Inherently abnormal lungs
- Early onset atopy
- Later environmental exposure including
What type of asthma does not exist?
Cough variant
How can we differentiate wheeze form other sounds?
- Over half of parents report generic respiratory sounds as wheeze
- True wheeze sounds like a whistle on expiration
What is the association between asthma and atopy?
- Does not “cause” asthma
- Atopy and asthma secondary to same process
- Family history
- Personal history
- Eczema
- Hayfever
- Food allergies
How is asthma treatment trialled?
2 month trial of ICS with steroid holiday after
What is the ideal presentation for asthma diagnosis?
- Wheeze with and without URTI
- SOB at rest
- Parental asthma
- Responds to treatment
What is the differential diagnosis for asthma with onset <5 years?
- Congenital
- CF
- PCD (Primary ciliary dyskinesia)
- Bronchitis
- Foreign body
What is the differential diagnosis for asthma with onset >5 years?
- Dysfunctional breathing
- Vocal cord dysfunction
- Habitual cough
- Pertussis
When is it unlikely to be asthma?
- Symptoms in under 18 months
- Most likely to be infection
- STILL MAY BE ASTHMA
What are the goals of asthma treatment?
- “Minimal” symptoms during day and night
- Minimal need for reliever medication
- No attacks (exacerbations)
- No limitation of physical activity
- Normal lung function
How is asthma control assessed?
SANE Questions
- Short acting beta agonist/week
- Absence school/nursery
- Nocturnal symptoms/week
- Excertional symptoms/week
What must be checked if asthma remains uncontrolled while on treatment?
- Compliance
- Taking medication correctly
- Diagnosis
What is the step up, step down approach to asthma?
- Start on low dose ICS
- Review after 2 months
What classes of medication can be used in asthma?
- Short acting beta agonists
- Inhaled corticosteroids (ICS)
- Long acting beta agonists
- Leukotriene receptor antagonists
- Theophyllines
- Oral steroids
How does child asthma management differ from adults?
- Max dose ICS 800 microg (<12 yo)
- No oral B2 tablet
- LTRA first line preventer in <5s
- No LAMAs
- Only two biologicals
When should a regular asthma preventer be added?
- Diagnostic test
- B2 agonists >two days a week
- Symptomatic three times a week or more, or waking one night a week
What adverse effects can occur with ICS?
- Height suppression (0.5-1cm)
- Oral candidiasis
- Adenocortical suppression (mainly fluticasone inhalers)
What 2 things do you need to remember about using a LABA in kids?
- Do not use without ICS
- Use as fixed dose inhaler
What is step 3 in asthma management?
Add on LABA
What leukotriene receptor antagonist is available for kids?
Montelukast
What biologic may be used in extremely resistant asthma?
Omalizumab
What types of delivery systems are used for children’s asthma medication?
- MDI with spacer
- Dry powder device
How can medication delivery be increased with a spacer?
- Shake inhaler between puffs
- Wash spacer monthly to reduce static
What is the role of dry powder inhalers in childhood asthma?
- Licensed in the over 5s
- Not used in the under 8s
- Achieve 20% lung deposition
- Generally girls use them at an earlier age than boys
What are the advantages of MDIs compare to nebulisers?
- Quieter
- Quicker
- Valve mechanism
- Don’t break down
- Portable
- Cheaper
What non-pharmacological management of asthma is there?
- Stop tobacco and smoke exposure
- Remove environmental triggers including animals
How are steroids used in asthma?
- Chronic/maintenance treatment= inhaled
- Acute treatment= oral
