Week 2 - Asthma In Children Flashcards
How are genetics involved in the development of asthma? (3)
80% hereditary
10 genetic variants contribute
Epigenetics (genes switched on)
Is the physiology of the airways normal before asthma symptoms are present?
No. Lining and airways are abnormal before symptoms start
What 3 symptoms must be included in asthma?
SoB, wheeze, cough
How many children in the uk have asthma?
1.1 million. 5% are on inhaled steroids
How does asthma and allergy correlate?
Majority of people with allergies don’t have asthma. 25% of people with asthma don’t have allergies. They’re not connected
What is the best way of diagnosing asthma?
HISTORY! Experimental tests not very useful as many diseases have similar symptoms and there isn’t 1 set test
What are 3 diagnostic tests for children with asthma?
- Spirometry before and after blue inhaler to test BDR response to blue inhaler (bronchodilator reversibility)
- NO test - testing levels of exhaled NO, which increase after inflammation of airways
- Peak flow test
What is the treatment upon suspicion of asthma?
ICS (brown inhaled corticosteroids) inhaler for 2 months. If symptoms go, inhaler works
What is a common issue following ICS prescription?
If child’s symptoms go away, parent may think the ICS worked. However their asthma may be transient and the symptoms are just gone temorarily
What are the benefits of ICS?
If it works. Improves quality of life and reduces risk of attacks
At which ages is it likely/not asthma?
Under 18 months, most likely infection
Over 5 years, most likely asthma
Under 5 years - hard to tell as tests are particularly ineffective
How do you measure control of asthma?
SANE
Short acting beta agonist (using inhaler +2 days a week?)
Absences from school
Nocturnal symptoms
Excertional symptoms (exercising)
What is the blue inhaler?
Short acting beta agonist - relaxed bronchi smooth muscle
What are add on preventers as well as ICS? (2)
Long acting beta agonists, in fixed dose inhaler with ICS
Leukotrine receptor antagonists (oral or granules)
What is the effects of Leukotrines?
Tightening of airways and excess mucus production
What adverse effects does ICS have on children?
Height, up to 1cm shorter
Oral thrush is teeth brushing isn’t performed
What further treatment is prescribed when asthma is poorly controlled using ICS?
LABA added on (correct answer in exams)
SOME GUIDELINES say increase ICS dosage
What treatment options are available for children suffering severe asthma?
Experimental medicine introduced
What is the difference between SABA and ICS?
ICS is a steroid, so reduces mucus and inflammation in airways
SABA is a beta agonist, so relaxes smooth muscle in the airways
What is the ideal delivery system for an inhaler?
Metre dose inhaler with a spacer, washed out with detergent prior to reduce static charge
What treatment should be used in more severe asthma cases?
IV salbutamol, hydrocortisone, aminophylline or magnesium. May need incubating and manual ventilation
What causes high levels of NO to be exhaled following an asthma exacerbation?
Inflammatory cytokines induce activation of nitrous oxide synthase
What is the differential diagnosis for asthma in children under 5? (5)
Cystic fibrosis, Primary ciliary dyskinesia, bronchitis, foreign body, Congenital disorder
How and when do we use LABA?
When brown inhaler isn’t working. We give it with ICS in a fixed dose inhaler
What is the first line preventer in adults and children?
ICS in kids and adults. LTRA if uncontrolled in under 5’s
What are the side effects of oral steroids?
Hypertension and cataracts
What are the 5 steps in BTS/Sign guidelines?
- Diagnosis and assessement
- Regular preventer
- Initial add on
- Additional add on
- High dose therapies
MDI spacer vs nebuliser?
Quieter, quicker, portable, cheap, don’t break down
What is an LTRA example?
Montelukast
