Week 2 - Asthma In Children

Question 1

How are genetics involved in the development of asthma? (3)

Answer 1

80% hereditary
10 genetic variants contribute
Epigenetics (genes switched on)

Question 2

Is the physiology of the airways normal before asthma symptoms are present?

Answer 2

No. Lining and airways are abnormal before symptoms start

Question 3

What 3 symptoms must be included in asthma?

Answer 3

SoB, wheeze, cough

Question 4

How many children in the uk have asthma?

Answer 4

1.1 million. 5% are on inhaled steroids

Question 5

How does asthma and allergy correlate?

Answer 5

Majority of people with allergies don’t have asthma. 25% of people with asthma don’t have allergies. They’re not connected

Question 6

What is the best way of diagnosing asthma?

Answer 6

HISTORY! Experimental tests not very useful as many diseases have similar symptoms and there isn’t 1 set test

Question 7

What are 3 diagnostic tests for children with asthma?

Answer 7

1. Spirometry before and after blue inhaler to test BDR response to blue inhaler (bronchodilator reversibility)
2. NO test - testing levels of exhaled NO, which increase after inflammation of airways
3. Peak flow test

Question 8

What is the treatment upon suspicion of asthma?

Answer 8

ICS (brown inhaled corticosteroids) inhaler for 2 months. If symptoms go, inhaler works

Question 9

What is a common issue following ICS prescription?

Answer 9

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

Question 10

What are the benefits of ICS?

Answer 10

If it works. Improves quality of life and reduces risk of attacks

Question 11

At which ages is it likely/not asthma?

Answer 11

Under 18 months, most likely infection
Over 5 years, most likely asthma
Under 5 years - hard to tell as tests are particularly ineffective

Question 12

How do you measure control of asthma?

Answer 12

SANE
Short acting beta agonist (using inhaler +2 days a week?)
Absences from school
Nocturnal symptoms
Excertional symptoms (exercising)

Question 13

What is the blue inhaler?

Answer 13

Short acting beta agonist - relaxed bronchi smooth muscle

Question 14

What are add on preventers as well as ICS? (2)

Answer 14

Long acting beta agonists, in fixed dose inhaler with ICS
Leukotrine receptor antagonists (oral or granules)

Question 15

What is the effects of Leukotrines?

Answer 15

Tightening of airways and excess mucus production

Question 16

What adverse effects does ICS have on children?

Answer 16

Height, up to 1cm shorter
Oral thrush is teeth brushing isn’t performed

Question 17

What further treatment is prescribed when asthma is poorly controlled using ICS?

Answer 17

LABA added on (correct answer in exams)
SOME GUIDELINES say increase ICS dosage

Question 18

What treatment options are available for children suffering severe asthma?

Answer 18

Experimental medicine introduced

Question 19

What is the difference between SABA and ICS?

Answer 19

ICS is a steroid, so reduces mucus and inflammation in airways
SABA is a beta agonist, so relaxes smooth muscle in the airways

Question 20

What is the ideal delivery system for an inhaler?

Answer 20

Metre dose inhaler with a spacer, washed out with detergent prior to reduce static charge

Question 21

What treatment should be used in more severe asthma cases?

Answer 21

IV salbutamol, hydrocortisone, aminophylline or magnesium. May need incubating and manual ventilation

Question 22

What causes high levels of NO to be exhaled following an asthma exacerbation?

Answer 22

Inflammatory cytokines induce activation of nitrous oxide synthase

Question 23

What is the differential diagnosis for asthma in children under 5? (5)

Answer 23

Cystic fibrosis, Primary ciliary dyskinesia, bronchitis, foreign body, Congenital disorder

Question 24

How and when do we use LABA?

Answer 24

When brown inhaler isn’t working. We give it with ICS in a fixed dose inhaler

Question 25

What is the first line preventer in adults and children?

Answer 25

ICS in kids and adults. LTRA if uncontrolled in under 5’s

Question 26

What are the side effects of oral steroids?

Answer 26

Hypertension and cataracts

Question 27

What are the 5 steps in BTS/Sign guidelines?

Answer 27

1. Diagnosis and assessement
2. Regular preventer
3. Initial add on
4. Additional add on
5. High dose therapies

Question 28

MDI spacer vs nebuliser?

Answer 28

Quieter, quicker, portable, cheap, don’t break down

Question 29

What is an LTRA example?

Answer 29

Montelukast