Resp - asthma

Question 1

3 main patterns of wheeze

Answer 1

viral induced wheeze
multiple trigger wheeze
asthma

Question 2

viral induced wheeze - who gets it and why

Answer 2

viruses cause wheeze in under 5s because their airways are already small, so they are quite easily narrowed to cause a wheeze

Question 3

multiple trigger wheeze - what is it

Answer 3

multiple things give you a wheeze; viruses, the cold, exercise etc
no interval symptoms though

Question 4

asthma - presentation

Answer 4

wheezes and interval symptoms
polyphonic wheeze
diurnal variation - worse at night/morning
non viral triggers
PMHx/FHx of atopy
12% FEV1 improvement with SABA

if chronic: chest hyperinflation, prolonged expiratory phase and Harrisons sulcus

Question 5

wheeze with acute rash, facial swelling, stridor

what is it - what treatment

Answer 5

anaphylaxis

adrenaline
chlorpheniramine
hydrocortisone
fluids

Question 6

other causes of wheeze

Answer 6

atypical pneumonia
CF
bronchopulmonary dysplasia
bronchiolitis obliterans
tracheo-bronchomalacia

Question 7

chronic asthma treatment

child presents with asthma, no treatment currently. What do you give first

Answer 7

SABA - salbutamol

Question 8

chronic asthma treatment
child presents with asthma, currently has a SABA
what do you add

Answer 8

Inhaled corticosteroid

Question 9

chronic asthma treatment

child presents with asthma, any age, on SABA and ICS - what do you do

Answer 9

add montelukast

Question 10

chronic asthma treatment

child presents with asthma, under 5 on SABA, ICS and LTRA - what next

Answer 10

refer them to respiratory paediactrican

Question 11

chronic asthma treatment

child presents with asthma over 5 on SABA, ICS and LTRA - what next

Answer 11

stop LTRA if not working and try LABA, increase ICS

Question 12

chronic asthma treatment

child presents with asthma, over 5, on SABA, ICS, has tried LTRA, taking LABA - what next?

Answer 12

increase ICS

Question 13

chronic asthma treatment

child presents with asthma, over 5, on SABA, ICS - now at a high dose, has tried LTRA, taking LABA - what next?

Answer 13

give oral prednisolone and refer them

Question 14

what features make you send a child to hospital for an asthma attack?

Answer 14

not responding to treatment
they are getting exhausted
FEV1 <50% predicted (their best effort normally)
sats <92%

Question 15

asthma attack - how severe is it, how to manage?
child can talk
sats above 92%
FEV1 above 50%

RR <40 HR <140 (in 2-5y.o))
RR <30 HR <125 (in 5-12 y.o)
RR<20 HR <110 (in 12-18)

Answer 15

moderate
salbutamol, up to 10 puffs
prednisolone (PO)

Question 16

asthma attack - how severe is it, how to manage?
child can not talk
sats below 92%
FEV1 33-50%

RR >40 HR >140 (in 2-5y.o))
RR >30 HR >125 (in 5-12 y.o)
RR >20 HR >110 (in 12-18)

Answer 16

severe
high flow oxygen
SABA - up to 10 puffs
Prednisoline PO or hydrocortisone IV
ipratropium inhaled
IV magnesium

Question 17

asthma attack - how severe is it?
silent chest
cyanosis
low respiratory effort, exhausted
low BP, arrhythmia
low GCS
FEV under 33%
sats under 92%

Answer 17

life threatening

high flow oxygen
SABA - up to 10 puffs
Prednisoline PO or hydrocortisone IV
ipratropium nebs
IV magnesium
?PICU/HDU