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
