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Year 5 Acute Care & Trauma > Y5 - Asthma and/or Viral induced wheeze in a child > Flashcards

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

1
Q

definition

A

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

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2
Q

epidemiology

A

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

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3
Q

aetiology

A

genetic and environmental

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4
Q

how much does genetics contribute to asthma

A

thought to be 75% based on twin studies

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5
Q

what environmental exposures are linked to asthma

A

allergens

viral infections

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6
Q

what are the three categories of wheeze in children

A

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

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7
Q

what are features of transient early wheezing

A

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

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8
Q

what are features of late onset wheezing

A

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

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9
Q

what are features of persistent wheezing

A

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

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10
Q

what gives a definitive diagnosis of asthma

A

a history of reversible airway obstruction which responds to bronchodilators

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11
Q

what are common presenting features of asthma in children

A

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

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12
Q

what other conditions may support asthma

A

eczema
atopic dermatitis
allergic rhinitis

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13
Q

what are signs of asthma in an acute exacerbation

A

widespread polyphonic wheeze

signs of respiratory distress (tachypnoea, accessory muscle use)

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14
Q

how does spirometry aid diagnosis of asthma

A

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

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15
Q

history and exam

A

RFs
wheezing
increased work of breathing
features of atopic disease

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16
Q

what sort of cough is commonly found in childhood asthma

A

dry night-time cough

17
Q

1st investigations to order

A

spirometry
response to bronchodilator
CXR

18
Q

what would be seen on spirometry

A 
obstructive pattern (on expiratory flow volume loop)
decreased FEV1/FVC ratio, or FEV1
19
Q

what response to a bronchodilator would be observed

A

12% improvement in FEV1 or FVC

20
Q

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

A 
step 1 (intermittent and exercise-induced asthma)
steps 2-6 (persistent)
21
Q

management for step 1 asthma in 0-4yrs

A

SABA when required and education

22
Q

what are the primary choices of SABA

A

salbutamol

levosalbutamol

23
Q

management for step 2 asthma in 0-4yrs

A

low dose ICS

plus SABA when required and education

24
Q

what are the primary choices of ICS

A

budesonide

fluticasone propionate

25
Q

why might a leukotriene receptor antagonists be useful in children

A

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

26
Q

management for step 3 asthma in 0-4yrs

A

medium dose ICS

plus SABA when required and education

27
Q

management for step 4 asthma in 0-4yrs

A

medium dose ICS and LRA (montelukast)

plus SABA when required and education

28
Q

management for step 5 asthma in 0-4yrs

A

high dose ICS and LRA (montelukast)

plus SABA when required and education

29
Q

management for step 6 asthma in 0-4yrs

A

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

30
Q

management for step 1 asthma in 5-11yrs

A

SABA when required and education

31
Q

management for step 2 asthma in 5-11yrs

A

low dose ICS

plus SABA when required and education

32
Q

management for step 3 asthma in 5-11yrs

A

medium dose ICS

plus SABA when required and education

33
Q

management for step 4 asthma in 5-11yrs

A

medium dose ICS and LABA or LRA

plus SABA when required and education

34
Q

management for step 5 asthma in 5-11yrs

A

high dose ICS and LABA or LRA

plus SABA when required and education

35
Q

management for step 6 asthma in 5-11yrs

A

high dose ICS and LABA or LRA and oral corticosteroid

plus SABA when required and education

36
Q

management for asthma in 12yrs plus

A 
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
37
Q

complications

A

asthma exacerbation

airway remodelling

38
Q

what is right middle lobe syndrome

A

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

Year 5 Acute Care & Trauma (35 decks)

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