Asthma - Clinical features in Children

Question 1

How is asthma diagnosed?

Answer 1

Symptom based diagnosis

Question 2

What are the symptoms identical to?

Answer 2

Lower Respiratory Tract Infections (LRTI)

Question 3

Definite sign of asthma

Answer 3

Wheeze

Question 4

What is an ICS and when would they be trialed?

Answer 4

Inhaled corticosteroids, trialed if QoL (quality of life) affected

Question 5

If there is no wheeze…. Will there be asthma?

Answer 5

NO!

Question 6

What are the symptoms of asthma?

Answer 6

Chronic Wheeze, cough, SOB (Shortness of Breath),

(with multible triggers, is reversiable/variable and responds to asthma treatment.)

Wheeze
Variability
Respond to treatment

Question 7

Asthma syndromes:

Answer 7

eg infant, child, adult, athlete, occupational (different triggers). Not one dingle cause for asthma.

Question 8

What causes asthma?

Answer 8

Genes
30-80% of causation
Interact with environment
Epigenetics

Question 9

How many genetic variations can impact the likelyhood to develop asthma?

Answer 9

~10 variants making modest contribution eg
ADAM33, ORMDL3.

“Genes load the gun the environment pullls the trigger”

Question 10

How many children have Asthma UK?

Answer 10

1.1 million UK children

5% of UK children on inhaled steroids!

Question 11

In studies where both parents had asthma, what preventative methods could be used for offspring to avoid developing asthma?

Answer 11

Feeding:

• Breast
• Late weaning

Avoiding Allergens:
- Ante- and post-natal (no pets and no house dust mites)

Avoiding Smoking

Question 12

What could be another diagnosis for a wheeze/wheezy cough/being chesty/recurrent “chest infections”?

Question 13

Name some of the inconsistencies in asthma

Answer 13

"Transient" vs persistent
VIW (viral induced wheeze) versus asthma/MTW (multi trigger wheeze)
Different severities
Different age for onset
Different effective treatment
Different triggers

Question 14

What 3 years are potentially the most important in terms of development of asthma?

Answer 14

First 3 years! The early environment causes childhood asthma.

Question 15

What is a NCD?

Answer 15

Non-communicable disease

Question 16

What affect does pre natal conditions and environment have on us developing asthma?

Answer 16

A lot!

Question 17

If a child’s quality of life is unaffected by the symptoms, what do you do?

Answer 17

Watch, wait and see what happens

Question 18

If a child’s quality of life is affected by the symptoms, what do you do?

Answer 18

Trial of inhaled steroids as a diagnostic test

Question 19

Why is an allergy test not much help in diagnosing asthma?

Answer 19

Most people with an allergy don’t have asthma, and 25% people with asthma don’t have an allergy.

Question 20

Why is spirometry not very helpful in diagnosis?

Answer 20

If normal can have asthma, if abnormal child might still not have asthma.

Question 21

What test might be helpful in diagnosing asthma in chil;dren and why?

Answer 21

Exhaled nitric Oxide as a test- tells you how much allergic inflammation in the lungs (Eosinophils produce NO

Question 22

What ages is the uncertainty the greatest and why?

Answer 22

Under 5’s as tests are even less reliable than normal

Question 23

Do children get Cough variant asthma?

Answer 23

No, only adults, although children may predominantly cough

Question 24

If a parent comes in saying that their child has a wheeze, how is best to tell if it is a wheeze or not?

Answer 24

If you ask them to describe the noise as more of a whistle or rattle. as most common 2 noises. More often than not is actually the rattle of bronchitis and not the whistle of asthma.

Question 25

What differentiates an asthmatic cough?

Answer 25

Asthmatic cough = dry, often nocturnal just after falling asleep and brought on by exercise

Question 26

How long does it take inhaled steroids to have their maximal effect?

Answer 26

2 months. No response after 2 months, then it doesn’t work.

Question 27

How do you eliminate “false positive” responses from children trialling brown inhaler for 2 months?

Answer 27

Get them on a “holiday” - take them off the medication and see if their symptoms come back

Question 28

What are the potential harms from doing a trial of treatment?

Answer 28

Cost
Hassle
Potentially 0.5-1cm height loss
Oral thrush

Question 29

Under 18 months is it more likely to be infection or asthma?

Over 5 years is it most likely to be infection or asthma?

Answer 29

Under 18 months = infection

Over 5 years = asthma