W2: ASTHMA CHILDREN & ADULTS

Question 1

Key signs and symptoms of Asthma

Answer 1

WHEEZE
CHRONIC
SOB, COUGH
MULTIPLE TRIGGERS
VARIABLE ONSET
ASTHMA TX SENSITIVITY

Question 2

ASTHMA AETIOLOGY

Answer 2

Host response to environment: IgE -> MC degran
Infection
Pre-existing. abn physiology
Syndrome
Genetics: ADAM33 & ORMDL3

Question 3

ASTHMA PATHOPHYSIOLOGY

Answer 3

Airway inflamm mediated by MC degran
=> widespread narrowing of airways
=> increased airway reactivity => narrowing => spontaneous + stimuli

Question 4

ASTHMA PREVALENCE

Answer 4

childhood 10-15% Males

adults 5-10% Females

Question 5

ASTHMA OBJECTIVE TEST

Answer 5

Exhaled NO - MOST OBJECTIVE (inflamm marker of epith.)

Question 6

ASTHMA MONITORING SEVERITY IN CHILDREN

Answer 6

SANE

SABA/week?
Absence from school?
Nocturnal sympt/week?
Excertional sympt/week?

Question 7

BTS SIGN (non-acute)

Answer 7

1. Low ICS (2mos review). INHALER HOLIDAY.
2. Low ICS +LABA (5yo+), +LTRA (<5yo - ORAL)
3. Increase [ICS]?; +LTRA or +LAMA
4. High [ICS], additional 4th therapy: Bagon tablet, SR Theopylline, LAMA, LTRA - SPECIALIST
5. Oral steroid? - SPECIALIST

Question 8

ASTHMA TX

Answer 8

• ICS (preventor): diagnostic, effective, safe. height stunt; oral candidiasis, adrenocortical suppr.
• LABA: in conj w/ ICS. FIXED DOSE INHALER.
• LTRA (leukotriene receptor. antagonist): under12s, ORAL.
• Theophyllines
• Oral steroids (UNCOMMON)
• SABA (blue), salbutamol MDI DPI
• Terbutaline (LABA). DPI
• Ipratropium bromide (LABA)
• Pred (Steroid)
• Omalizumab anti. IgE
• mepolizumab anti IL-5.

> MDI w/ SPACER DEVICE - greater efficacy. washing reduces static charge.
DRY POWDER DEVICE
NEBULISER

Question 9

ACUTE MGMT

Answer 9

1. SABA (spacer), +oral prednisolone (steroid)
2. SABA (nebuliser) + preD
   SABA + ipra (neb) + pred
3. SABA (IV), Mg (neb),Hydrocortisone. (ORAL), Theop/Bronchodilators

INTUBATION + VENTILATION. 1hrREVIEW

Question 10

NonPharma Mgmt

Answer 10

• vaccination
• exercise
• smoking cessation
• Wt mgmt

=> Asthma plan w/ GP + asthma nurse

Question 11

Differentiate the main causes of wheezing illness

Answer 11

• ASTHMA
• ALLERGIES
• INFECTION
• REFLUX DISEASE
• CONGENITAL
• CF
• BRONCHITIS
• FOREIGN BODY
• BREATTHING / VOCAL CORD DYSFUNCT.
• HABITUAL COUGH
• PERTUSSIS

Question 12

possible reasons for the changing prevalence and severity of respiratory disease with child’s age and possible links with respiratory disease in adult life.

Answer 12

ADULT RISK FACTOR:

1. genetic susceptibility (1º family significance)
2. ATOPY: predisp. to developing IgE. against environment allergies + inheritable => rhinitis, asthma, hayfever, eczema
3. SMOKING: maternal increase r.Factor
4. OCCUPATIONAL => chemical fumes, gases, dust or other substances on the job

Question 13

Define the investigations used to diagnose asthma

Answer 13

1. Spirometry = FEV1:FVC
2. Pulm. Funct Test = excludes COPD
3. Reversibility of Bronchodilators/ Oral Corticosteroids (peak flow measure/time)
4. Airway responsiveness: inhale metacholine/histamine/mannitol. = bronchial hyper responsiveness
5. FeNO inhalation: inflamm