asthma

Question 1

in children what is the aetiology of asthma?

Answer 1

environment, infection, abnormal physiology, hereditary factors and also epithelial abnormality exposed to allergy may fuel asthma

Question 2

how do you diagnose asthma in children?

Answer 2

no diagnostic test, often causes a dry nocturnal cough, a wheeze and affects quality of life but responds to treatment
spirometry then bronchodilator response then nitric oxide test then peak flow

Question 3

what is asthma?

Answer 3

chronic panting, wheeze, cough, shortness of breath when at rest

Question 4

what is a predominant trigger for asthma in children?

Answer 4

upper respiratory tract infection

Question 5

what are the 6 meds used for asthma in children ?

Answer 5

short acting beta agonist
inhales corticosteroids (ICS)
leukotriene receptor antagonist
theophylline
oral steroids

Question 6

what are the first line preventers in under 5’s?

Answer 6

ICS and LTRA

Question 7

whats the max dosage of ICS in children?

Answer 7

800micrograms

Question 8

what are some negative effects of ICS in children?

Answer 8

0.5-1cm decrease in height
oral thrush
adrenocortical supply with purple and orange inhalers

Question 9

if a child patient is poorly controlled in low dose of ICS what should you add?

Answer 9

LABA

Question 10

what are the goals of treatment in children with asthma?

Answer 10

minimal symptoms
minimal need for relief meds
no attacks
no limitation in physical activity

Question 11

in children diagnosis of asthma what does SANE stand for?

Answer 11

S-short acting beta agonist (more than twice a week)
A-absence from school etc
N-nocturnal symptoms
E-exceptional symptoms

Question 12

what are the 2 delivery systems used in children ?

Answer 12

metered dose inhaler with spacer device (8% deposition)

dry powder device- not for under 5’s and boys cannot use until 8, 20% lung deposition

Question 13

how should a metered dose inhaler with space device be used?

Answer 13

shake inhaler between puffs and wash with thin layer of detergent monthly to reduce static

Question 14

what meds would you use in children with mild asthma?

Answer 14

SABA via spacer or SABA+prednisolone (pred)

Question 15

whats meds would you use in children with moderate asthma?

Answer 15

SABA via nebuliser+prednisolone

SABA+epitome bromide via nebuliser+prednisolone

Question 16

what meds would you use in children with severe asthma?

Answer 16

intravenous- salbutamol
aminophylline
magnesium+prednisolone
hydrocortisone
intimate and ventilate is very severe, rare cases!

Question 17

in children how do you choose between medication?

Answer 17

respiratory rate
work of breathing
heart rate
O2 saturations
ability to complete sentences
confusion
air entry

Question 18

how would chronic vs acute asthma be treated in children?

Answer 18

chronic- inhaled steroid

acute- oral steroids

Question 19

what are risk factors in adults?

Answer 19

hereditary(mostly maternal)
smoking
occupation
environmental

Question 20

what is meant by atopy?

Answer 20

the body’s predisposition to develop IgE in response to exposure to environmental allergens
atopy is inheritable and associated with allergic rhinitis, asthma, hay fever and eczema

Question 21

what are symptoms of asthma in adults?

Answer 21

medical history, wheeze, dyspnoea, chest tightness, dry cough and sputum

Question 22

whats some evidence of variable symptoms?

Answer 22

daily variation- nocturnal, early in the morning
weekly variation- occupation, does is go away on weekends? or on holiday?
annual variation- environmental allergens

Question 23

what could trigger asthma in adults?

Answer 23

exercise, cold air, cigarettes, respiratory tract infection, pets, pollen, drugs and food

Question 24

what are some clinical symptoms that could point to another diagnosis that not asthma?

Answer 24

finger clubbing
stridor (inspiratory wheeze instead of expiratory)
asymmetrical expansion
crepitations (crackles)

Question 25

how would you measure the severity of an acute asthma episode ?

Answer 25

``` ability to speak heart rate respiratory rate peak flow O2 saturation arterial blood gas ```

Question 26

what symptoms would a patient with moderate acute asthma present?

Answer 26

``` able to speak heart rate less than 110bpm respiratory rate less than 25 peak flow 50-75% SaO2 less than or equal to 92% PaO2 less than or equal to 8kPa ```

Question 27

what symptoms would a patient with severe acute asthma present ?

Answer 27

inability to complete sentences in one breath heart rate more than or equal to 110bpm respiratory rate more than or equal to 25 peak flow 35-50% SaO2 less than or equal to 92% PaO2 less than or equal to 8kPa

Question 28

what symptoms would a patient with life threatening acute asthma present?

Answer 28

``` grunting impaired consciousness ad confusion bradycardia (less than 60bpm), arrhythmia, hypotension peak flow less than 33% cyanosis(skin or lips turn blue) silent chest SaO2 less than 92% PaO2 less than 8kPa PaCO2 normal ```

Question 29

what symptoms would a patient with near fatal acute asthma present?

Answer 29

raised PaCO2 | needs medical ventilation

Question 30

what are non pharmacological ways to manage asthma ?

Answer 30

exercise smoking cessation weight management patient education

Question 31

what are the SABA relievers used in adults?

Answer 31

salbutamol | terbutaline

Question 32

what oral therapy meds are used in adults?

Answer 32

LTRA theophylline prednisolone

Question 33

what are some specialist therapies used in rare and severe cases of asthma in adults?

Answer 33

omalizumab mepolizumab bronchial thermoplasty