Clinical Features of Asthma in Children Flashcards
What symptom is crucial to be present for a diagnosis of asthma to be made?
Wheeze
No wheeze, no asthma
What is the most reliable way of confirming a diagnosis of asthma?
Putting the patient on a trial of inhaled corticosteroids (ICS) and seeing if their symptoms resolve
Only done if the asthma is affecting the childs QOL, otherwise just observe and wait when symptoms seen
What are the main symptoms of asthma? In what sort of pattern does the disease tend to manifest?
Wheeze
Cough
Shortness of breath
Has a variable and reversible manifestation, reverses with medication and varies in when and for how long it presents
What is the most common trigger of asthma in young children?
Upper respiratory tract infection
What are the “key words” when it comes to asthma?
- Wheeze
- Variability (of symptoms / course)
- Responds to treatment
Is asthma genetically inherited?
“the genes load the gun, the environment pulls the trigger”
If you have asthma genes you may be very predisposed to the condition, but interaction with environment is necessary for asthma to present
(but yeah 30-80% of asthma associated with genetic mutations - around 10 genes each with a part to play)
Do allergies cause asthma?
Nah
Inherent problem with the epithelium allows the allergen entry and the opportunity to stimulate the immune system, causing allergy
The allergy then fuels the asthma
What percentage of UK children are on inhaled steroids?
5%
What investigations may be done to help diagnose asthma?
No specific test to diagnose but these are useful:
- Spirometry
- BDR (bronchodilator response to blue inhaler)
- Nitric oxide (FeNO)
- PEFR
How is spirometry done?
Get the kid to put a breathing tube thingy in their mouth and ask them to breathe:
- At tidal volume
- Max inhale and max exhale
What does a high value on a nitric oxide test mean?
Airways are inflamed (have a high white cell count)
What is a very important question to ask the parent when taking an asthma history?
To describe the wheeze the child has
Many “wheezes” are actually rattles and so are indicative of bronchitis, not asthma
“Is the wheeze more of a rattle or a whistling sound?”
What type of cough do asthma patients tend to have?
Dry
Nocturnal (just after falling asleep)
Exertional (during exercise)
What is the minimum amount of time an inhaled corticosteroid treatment should be prescribed for?
2 months
Takes 2 months for the brown inhaler to have an effect, needs to be used consistently
If it hasn’t worked after 2 months it doesn’t work
How do you tell if there has been a false positive response when using inhaled corticosteroids?
Take the child off the inhaler for a bit after they have obtained the positive result following 2 months of use
If symptoms don’t come back there was a false positive
