Y5 - Asthma and/or Viral induced wheeze in a child

Question 1

definition

Answer 1

a chronic respiratory disorder characterised by variable airway inflammation, airway obstruction, and airway hyperresponsiveness

Question 2

epidemiology

Answer 2

most common chronic respiratory disease in the developed world
higher prevalence in prepubertal males and postpubertal females

Question 3

aetiology

Answer 3

genetic and environmental

Question 4

how much does genetics contribute to asthma

Answer 4

thought to be 75% based on twin studies

Question 5

what environmental exposures are linked to asthma

Answer 5

allergens

viral infections

Question 6

what are the three categories of wheeze in children

Answer 6

1 transient early wheezing
2 late-onset wheezing
3 persistent wheezing

Question 7

what are features of transient early wheezing

Answer 7

1 or more episodes of LRTI w/ wheezing in first 3yrs of life but none by 6yrs

Question 8

what are features of late onset wheezing

Answer 8

no LRTIs w/ wheezing in first 3yrs, but no wheezing at 6yrs

Question 9

what are features of persistent wheezing

Answer 9

1 or more episodes of LRTI w/ wheezing in first 3yrs and wheezing at 6yrs too

Question 10

what gives a definitive diagnosis of asthma

Answer 10

a history of reversible airway obstruction which responds to bronchodilators

Question 11

what are common presenting features of asthma in children

Answer 11

recurrent symptoms of wheezing, dry cough (esp. at night or early morning)
also SOB in response to changes in temperature, viral infections, exercise, emotion

Question 12

what other conditions may support asthma

Answer 12

eczema
atopic dermatitis
allergic rhinitis

Question 13

what are signs of asthma in an acute exacerbation

Answer 13

widespread polyphonic wheeze

signs of respiratory distress (tachypnoea, accessory muscle use)

Question 14

how does spirometry aid diagnosis of asthma

Answer 14

presence of a beta-2 agonist bronchodilator response, 12% or more improvement on FEV1 or FVC

Question 15

history and exam

Answer 15

RFs
wheezing
increased work of breathing
features of atopic disease

Question 16

what sort of cough is commonly found in childhood asthma

Answer 16

dry night-time cough

Question 17

1st investigations to order

Answer 17

spirometry
response to bronchodilator
CXR

Question 18

what would be seen on spirometry

Answer 18

obstructive pattern (on expiratory flow volume loop)
decreased FEV1/FVC ratio, or FEV1

Question 19

what response to a bronchodilator would be observed

Answer 19

12% improvement in FEV1 or FVC

Question 20

what are the 6 steps of management for 0-4yrs

Answer 20

step 1 (intermittent and exercise-induced asthma)
steps 2-6 (persistent)

Question 21

management for step 1 asthma in 0-4yrs

Answer 21

SABA when required and education

Question 22

what are the primary choices of SABA

Answer 22

salbutamol

levosalbutamol

Question 23

management for step 2 asthma in 0-4yrs

Answer 23

low dose ICS

plus SABA when required and education

Question 24

what are the primary choices of ICS

Answer 24

budesonide

fluticasone propionate

Question 25

why might a leukotriene receptor antagonists be useful in children

Answer 25

e.g. montelukast (a once-daily oral formulation - useful for compliance issues)

Question 26

management for step 3 asthma in 0-4yrs

Answer 26

medium dose ICS

plus SABA when required and education

Question 27

management for step 4 asthma in 0-4yrs

Answer 27

medium dose ICS and LRA (montelukast)

plus SABA when required and education

Question 28

management for step 5 asthma in 0-4yrs

Answer 28

high dose ICS and LRA (montelukast)

plus SABA when required and education

Question 29

management for step 6 asthma in 0-4yrs

Answer 29

high dose ICS, LABA/LRA (montelukast), and oral corticosteroid
plus SABA when required and education

Question 30

management for step 1 asthma in 5-11yrs

Answer 30

SABA when required and education

Question 31

management for step 2 asthma in 5-11yrs

Answer 31

low dose ICS

plus SABA when required and education

Question 32

management for step 3 asthma in 5-11yrs

Answer 32

medium dose ICS

plus SABA when required and education

Question 33

management for step 4 asthma in 5-11yrs

Answer 33

medium dose ICS and LABA or LRA

plus SABA when required and education

Question 34

management for step 5 asthma in 5-11yrs

Answer 34

high dose ICS and LABA or LRA

plus SABA when required and education

Question 35

management for step 6 asthma in 5-11yrs

Answer 35

high dose ICS and LABA or LRA and oral corticosteroid

plus SABA when required and education

Question 36

management for asthma in 12yrs plus

Answer 36

step 1 
-SABA when required and education
step 2
-low dose ICS plus SABA and education
step 3
-medium dose ICS plus SABA and education
step 4
-medium dose ICS plus LABA/LRA/theophylline plus SABA and education
step 5
-high dose ICS and LABA/LRA/theophylline plus SABA and education
step 6
-high dose ICS and LABA/LRA/theophylline and oral corticosteroid plus SABA and education

Question 37

complications

Answer 37

asthma exacerbation

airway remodelling

Question 38

what is right middle lobe syndrome

Answer 38

accentuated middle lobe bronchus obstruction leads to atelectasis and consolidation as a result of hilar lymph node enlargement