1: Resp - Asthma Flashcards by Grace Poole

What is asthma

Chronic disease with airway inflammation, bronchial hyper-reactivity and reversible airway obstruction

How well did you know this?

Not at all

Perfectly

What age will the majority of cases of childhood asthma present before

10y

How well did you know this?

Not at all

Perfectly

Give 5 triggers for asthma

Exercise
Dust mite
Smoking
Viruses
Pollen
Fur/Feathers

How well did you know this?

Not at all

Perfectly

What are 5 risk factors for asthma

FH
Low birth weight
Parents smoking
Bottle fed
ADAMS33 gene
History eczema or allergic rhinitis

How well did you know this?

Not at all

Perfectly

How will asthma present in a child

Dyspnoea
Nocturnal cough
Chest tightness
Expiratory wheeze

How well did you know this?

Not at all

Perfectly

In which age-group is breathlessness more common

Pre-School

How well did you know this?

Not at all

Perfectly

What type of asthma do children typically have

Exercise-Induced

How well did you know this?

Not at all

Perfectly

What are three signs of long-standing asthma

Barelled chest
Polyphonic expiratory wheeze
Harrison Sulci

How well did you know this?

Not at all

Perfectly

What is a Harrison sulci

If asthma is present during infancy, there will be a horizontal line along lower border of the thorax due to costal insertion of diaphragm

How well did you know this?

Not at all

Perfectly

What is first-line investigation for asthma

Spirometry and Bronchodilator Reversibility Testing

How well did you know this?

Not at all

Perfectly

When is spirometry with reversibility suitable

Children >5Y

How well did you know this?

Not at all

Perfectly

What is a positive test with spirometry and bronchodilator reversibility

Improvement in FEV1 >12% with bronchodilator

How well did you know this?

Not at all

Perfectly

What does a negative test in spirometry and bronchodilator reversibility mean

Does not exclude a diagnosis of asthma

How well did you know this?

Not at all

Perfectly

When is spirometry and bronchodilator reversibility not suitable

If a child is under 5

How well did you know this?

Not at all

Perfectly

What is second-line investigation in children with asthma

Peak Expiratory Flow

How well did you know this?

Not at all

Perfectly

What is a positive result on peak expiratory flow

Diurnal variability of more than 20%

How well did you know this?

Not at all

Perfectly

What does a ‘negative’ peak expiratory flow result mean

Does not exclude a diagnosis of asthma

How well did you know this?

Not at all

Perfectly

What is third-line investigation for asthma

Direct Challenge Test

How well did you know this?

Not at all

Perfectly

What is the direct challenge test

Histamine or Methacholine are administered at increasing doses. The dose at which a 20% reduction in FEV1 is noted

How well did you know this?

Not at all

Perfectly

What is a positive test

Concentration <8 required to reduce FEV1 by 20%

How well did you know this?

Not at all

Perfectly

What does a negative methacholine challenge test mean

In schoolchildren, a negative methacholine test makes a diagnosis of asthma unlikely

How well did you know this?

Not at all

Perfectly

What is the exercise challenge

Fall in FEV1 of 15% on exercising

How well did you know this?

Not at all

Perfectly

What does a positive exercise challenge indicate

Highly indicates asthma in school-aged children

How well did you know this?

Not at all

Perfectly

When can FeNO only be performed

Children >3-4Y

How well did you know this?

Not at all

Perfectly

What FeNO is a positive test in children

>35ppb

What FeNO is positive in adults

>40ppb

Why may a skin prick test be performed

to look for atopy

How does a positive skin prick test affect the probability of the condition being asthma

increases probability it is asthma in school children

Following clinical assessment what is first-line investigation in children >5Y

Spirometry and bronchodilator reversibility testing

If spirometry and bronchodilator reversibility is positive, what should be done

Trial of treatment and repeat LFTs

If spirometry and bronchodilator reversibility are negative, what should be done

FeNO or Direct Challenge Test

What is the problem with diagnosing asthma in children under 5

Cannot undergo spirometry

Describe how asthma is diagnosed in under 5Y

- Watchful waiting and review | - Monitored initiation of treatment

What is first-line management for 5-16Y with asthma

SABA

What is second line for 5-16Y with asthma

Very Low Dose Paediatric Corticosteroids

What is third line for 5-16Y with asthma

LTRA or LABA

What is fourth-line management of 5-16Y with asthma

Increase dose to low dose inhaled corticosteroids

What is fifth-line management of 5-16Y with asthma

Specialist

What is first line asthma management in children under 5

SABA

What is second line asthma management in children under 5

LTRA | Or v.low dose paediatric ICS

what is third line asthma management in children under 5

Very Low Dose Paediatric ICS | LTRA

what is fourth-line asthma management in children under 5

LABA

what is fifth-line asthma management in children under 5

Specialist

what type of inhaler should children under 5 be offered

MDI with spacer

what type of inhaler should children 5-12Y be offered

MDI with spacer of dry-powered inhaler

What agent is preferred to treat asthma is atopic history

LTRA

How will asthma present in pre-school children (0-3)

Recurrent wheezing often triggered by viral upper airway infection

How will asthma present in school children (5-12)

- Nocturnal Cough - Exercise- Induced Cough - Chest tightness - Wheeze

What often causes asthma attacks in Children

Viral illness leading to recurrent wheeze

How are asthma attacks graded in children

- Moderate - Acute severe - Life-threatening

What are 5 features of moderate acute asthma attack in children <5Y

1. Able to talk in full sentences 2. SpO2 > 92% 3. PEFR >50% 4. HR (depends on age) 5. RR (depends on age)

What is the HR in moderate asthma attack in a. Children 1-5y b. Children >5y

a. <140bpm | b. <125bpm

What is the RR in moderate asthma attack in a. Children 1-5y b. Children >5y

a. <40 | b. <30

What are 5 features of acute severe asthma in children

1. Unable to talk in full sentences 2. SpO2 <92% 3. PEFR: 33-50 4. HR (age-dependent) 5. RR (age-depdentent)

In acute severe asthma, what is the HR if a. 1-5 b. >5

a. >140 | b. >125

In acute severe asthma, what is the RR if a. 1-5 b. >5

a. >40 | b. >30

What are 6 signs of life-threatening asthma

- Exhaustion - Cyanosis - Hypotension - Silent chest - Poor respiratory effort - Confusion

What are two measurements in life-threatening asthma

- PEF <33 | - SpO2 <92

What is first-line management of an asthma attack in children

Salbutamol

How is salbutamol given in a moderate asthma attack

Via spacer and face mask

How is salbutamol given in acute severe or life-threatening asthma

Nebulised

What dose of salbutamol is given

2.5mg via oxygen-driven nebuliser

What is second-line management of asthma attack in children

Ipratropium Bromide

What dose of ipratropium bromide is given

250 micrograms

What is third-line management of asthma attack in children

Oral prednisolone

What dose of oral prednisolone is given if a. <2Y b. 2-5Y c. >5Y

a. 10mg b. 20mg c. 30-40mg

How long is oral prednisolone continued for

3 Days post asthma attack

What may be given in acute severe or life-threatening asthma

Nebulised Magnesium Sulphate

What dose of magnesium sulphate is given

150mg

If child is not responding to asthma management, what is given

IV Salbutamol IV aminophylline IV magnesium

What are three requirements prior to discharge in child with asthma

PEF >75% Asthma action plan Inhaler technique checked

When is a child followed up | a. at the GP, b. in clinic following an asthma attack

a. 1W | b. 4W

How old does a child need to be to be diagnosed with asthma

>4Y

1: Resp - Asthma Flashcards

(73 cards)