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Paediatrics > Respiratory - Asthma > Flashcards

Respiratory - Asthma Flashcards

1
Q

What is asthma?

A
  • Chronic respiratory condition characterised by variability and reversibility
  • Presents with wheeze, cough and SOB
  • Multiple triggers
  • Responds to asthma treatment
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2
Q

Give examples of asthma triggers.

A
  • URTI
  • Exercise
  • Allergen
  • Cold weather
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3
Q

What is the epidemiology of asthma?

A
  • 1 million UK children
  • 100, 000 in Scotland
  • 5% of UK children on inhalers
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4
Q

What is the multiple hits theory of asthma?

A
  • Genes
  • Inherently abnormal lungs
  • Early onset atopy
  • Later environmental exposure including
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5
Q

What type of asthma does not exist?

A

Cough variant

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6
Q

How can we differentiate wheeze form other sounds?

A
  • Over half of parents report generic respiratory sounds as wheeze
  • True wheeze sounds like a whistle on expiration
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7
Q

What is the association between asthma and atopy?

A
  • Does not “cause” asthma
  • Atopy and asthma secondary to same process
  • Family history
  • Personal history
    • Eczema
    • Hayfever
    • Food allergies
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8
Q

How is asthma treatment trialled?

A

2 month trial of ICS with steroid holiday after

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9
Q

What is the ideal presentation for asthma diagnosis?

A
  • Wheeze with and without URTI
  • SOB at rest
  • Parental asthma
  • Responds to treatment
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10
Q

What is the differential diagnosis for asthma with onset <5 years?

A
  • Congenital
  • CF
  • PCD (Primary ciliary dyskinesia)
  • Bronchitis
  • Foreign body
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11
Q

What is the differential diagnosis for asthma with onset >5 years?

A
  • Dysfunctional breathing
  • Vocal cord dysfunction
  • Habitual cough
  • Pertussis
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12
Q

When is it unlikely to be asthma?

A
  • Symptoms in under 18 months
    • Most likely to be infection
    • STILL MAY BE ASTHMA
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13
Q

What are the goals of asthma treatment?

A
  • “Minimal” symptoms during day and night
  • Minimal need for reliever medication
  • No attacks (exacerbations)
  • No limitation of physical activity
  • Normal lung function
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14
Q

How is asthma control assessed?

A

SANE Questions

  • Short acting beta agonist/week
  • Absence school/nursery
  • Nocturnal symptoms/week
  • Excertional symptoms/week
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15
Q

What must be checked if asthma remains uncontrolled while on treatment?

A
  • Compliance
  • Taking medication correctly
  • Diagnosis
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16
Q

What is the step up, step down approach to asthma?

A
  • Start on low dose ICS
  • Review after 2 months
17
Q

What classes of medication can be used in asthma?

A
  • Short acting beta agonists
  • Inhaled corticosteroids (ICS)
  • Long acting beta agonists
  • Leukotriene receptor antagonists
  • Theophyllines
  • Oral steroids
18
Q

How does child asthma management differ from adults?

A
  • Max dose ICS 800 microg (<12 yo)
  • No oral B2 tablet
  • LTRA first line preventer in <5s
  • No LAMAs
  • Only two biologicals
19
Q

When should a regular asthma preventer be added?

A
  • Diagnostic test
  • B2 agonists >two days a week
  • Symptomatic three times a week or more, or waking one night a week
20
Q

What adverse effects can occur with ICS?

A
  • Height suppression (0.5-1cm)
  • Oral candidiasis
  • Adenocortical suppression (mainly fluticasone inhalers)
21
Q

What 2 things do you need to remember about using a LABA in kids?

A
  • Do not use without ICS
  • Use as fixed dose inhaler
22
Q

What is step 3 in asthma management?

A

Add on LABA

23
Q

What leukotriene receptor antagonist is available for kids?

A

Montelukast

24
Q

What biologic may be used in extremely resistant asthma?

A

Omalizumab

25
Q

What types of delivery systems are used for children’s asthma medication?

A
  • MDI with spacer
  • Dry powder device
26
Q

How can medication delivery be increased with a spacer?

A
  • Shake inhaler between puffs
  • Wash spacer monthly to reduce static
27
Q

What is the role of dry powder inhalers in childhood asthma?

A
  • 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
28
Q

What are the advantages of MDIs compare to nebulisers?

A
  • Quieter
  • Quicker
  • Valve mechanism
  • Don’t break down
  • Portable
  • Cheaper
29
Q

What non-pharmacological management of asthma is there?

A
  • Stop tobacco and smoke exposure
  • Remove environmental triggers including animals
30
Q

How are steroids used in asthma?

A
  • Chronic/maintenance treatment= inhaled
  • Acute treatment= oral

Paediatrics (38 decks)

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