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Asthma - Children Flashcards

(55 cards)

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1
Q

What are the challenges with asthma?

A

No clear definition
No tests
Two national guidelines
Symptom based
Identical to LRTI symptoms
Relapse and remission

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2
Q

In children, No asthma no..

A

wheeze

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3
Q

What is asthma?

A

Chronic
Wheeze, cough and shortness of breath
Multiple triggers
Variable
Reversible
Responds to asthma treatment

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4
Q

What 4 things do we know that about causing asthma?

A

Host response to environment
Infection is important
Physiology is abnormal before symptoms
Is a syndrome

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5
Q

What are some inconsistencies?

A

Transient vs persistent syndromes
VIW versus asthma
Different severities, age of onset and triggers
Heterogeneity in response

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6
Q

Describe genes and asthma in children

A

Genes contribute to 30-80% of causation
10 variants that can make contribution
Genes can include ADAM33 and ORMDL3 but people can have these and not have asthma
These genes interact with the environment
Epigenetics can be the reason for this

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7
Q

Explain allergy and asthma

A

Allergy probably does not cause asthma but a primary epithelial abnormality in skin/gut/airway can result in -eczema/asthma etc. and allergy.
The allergy then fuels eczema/asthma etc.

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8
Q

Give stats of asthma in children in UK

A

1.1 million UK children
110,000 in Scotland
5% of children on inhaled steroids
Asthma prevalence is on the decline from 2004

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9
Q

What is likely for the rise and fall of asthma?

A

Diagnostic enthusiasm
Increasing recognition
True rise

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10
Q

What is the age of lungs having 100% FEV1?

A

25 years

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11
Q

What diagnostics tests are used in asthma?

A

No tests in children for asthma - peak flow, allergy tests, spirometry and exhaled nitric oxide
Can help exclude diseases

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12
Q

What is a exhaled nitric oxide test?

A

Is unproven to diagnose asthma in children
It measures the amount of nitric oxide that is exhaled from a breath. Increased levels of nitric oxide are associated with swelling of lung airways

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13
Q

What 4 tests are used to exclude other diseases to give diagnosis of asthma?

A

1.spirometry
2. BDR
3.FeNO
4.Peak flow

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14
Q

Does a cough variant asthma exist in children?

A

No

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15
Q

What type of wheeze is associated with asthma in children

A

Whistle not a rattle

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16
Q

Explain what shortness of breath at rest is like in asthma?

A

Significant respiratory difficulty <30% lung function
Airway obstruction
Can be sooking in of the ribs with wheeze - stomach sticks out of ribs

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17
Q

Describe what a cough is like in a child with asthma

A

Dry
Nocturnal - just after falling asleep
Exertional

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18
Q

What personal history can be circumstantial evidence of asthma?

A

Eczema, Hay fever, Food allergies
Any allergies are circumstantial evidence
Hereditary

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19
Q

What does treatment for asthma look like in children?

A

ICS for 2 months
Then false positive responses need to be checked so a holiday in Easter is taken from treatment

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20
Q

Does asthma symptoms respond to treatment?

A

yes

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21
Q

What would give an ideal diagnosis

A

Responds to treatment

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22
Q

What are some disadvantages of asthma treatment?

A

Cost
Hassle
0.5-1cm loss in height
Oral thrush if teeth not brushed after inhaler use

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23
Q

What are some benefits of asthma treatment?

Study These Flashcards
A

Helps diagnosis
If symptoms are responding
Improves QoL
Reduces risk of attacks

24
Q

What is the approach to a reported wheeze?

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A

Is it genuine - whistle, sleep disturbance
Can watch and see if continues or trail with treatment
If treatment helps then asthma - remember Easter holiday

25
What can be a differential diagnosis for asthma in under 5s?
Congenital Cystic Fibrosis Primary ciliary dyskinesia Bronchitis Foreign body
26
What can be a differential diagnosis for asthma in over 5s?
Dysfunctional breathing Vocal cord dysfunction Habitual cough - chronic cough with no underlying cause or diagnosis Pertussis - highly infectious airway infection
27
What is the difference between asthma and VIW?
They are the same condition 99% of VIW is preschool children These is no intervals of wheezing in VIW Both treated with bronchodilators
28
What is the approach to preschool cough?
Is it an associated wheeze - yes then wheeze algorithm no then is it moist/dry Dry - watch and see Moist - if shows red flags then might be bronchiectasis no then bacterial bronchitis or other related diseases
29
What is treatment to mild asthma in children?
SABA via spacer SABA via spacer + prednisone
30
What is treatment to moderate asthma in children?
SABA via nebulizer + prednisone SABA + ipratropium via nebulizer + prednisone
31
What is the treatment to severe asthma in children?
IV salbutamol IV aminophylline IV magnesium IV hydrocortisone Intubate and ventilate
32
What do you do in acute asthma?
Start treatment and reassess in 1 hour Step up or down where appropriate
33
What type of steroids are used in chronic/maintenance treatment?
Inhaled steroids
34
What type of steroids are used in acute treatment?
Oral steroids
35
What are the steps for treating acute asthma in children?
The level of treatment is determined by symptoms and sats Treat and reassess Be guided by sats/O2 requirement
36
What are the goals to treating non acute asthma?
Minimal symptoms during the day and night Minimal need for reliever medication No attacks/ exacerbations No limitation for physical activity
37
How do we measure control?
Closed questions Use SANE Short acting beta agonist/week Absence from school or nursery Nocturnal symptoms/week Exertional symptoms
38
When would you reduce treatment?
Reduce treatment if symptom free for 3 months and watch to see result
39
What is the step up step down approach?
Started on low dose ICS - severe may respond to minimal treatment Review after 2 months - need an inhaler holiday
40
What are the classes of medication used in non acute asthma?
SABA - blue relieving inhaler Inhaled corticosteroids (ICS) Oral steroids LABA, Leukotriene receptor antagonists and theophylline are add ons
41
What is the contrast with adults for treatment in non acute asthma?
Max dose ICS 800 micrograms in under 12s No oral B2 tablet LTRA first line preventer in under 5s No LAMAs Only two biologicals
42
What treatment would you give to a child taking a B2 agonist more than 2 days a week and being symptomatic for 3 days or waking one night a week?
Start with very low dose of inhaled corticosteroids or LTRA in under 5s
43
What are benefits of ICS?
Useful for diagnosis Very effective when taken Very safe when correctly prescribed
44
What are the dose response for ICS on a graph?
If increased from 200 to 400 the positive effects increase, but doubling after will not change positive effects
45
What are the dose response for ICS on a graph?
If increased from 200 to 400 the positive effects increase, but doubling after will not change positive effects Also there is not much increase in adverse effects if you increase drug
46
Adverse effects of ICS?
Height suppression Maybe oral candidiasis Adrenocortical suppression No hypertension or cataracts
47
What are two thing to remember with LABA?
Do not use without ICS Used as fix dose inhaler Is an add on preventer
48
What is leukotriene receptor antagonist?
Montelukast only in children Rule of thirds - 1/3 benefits, no benefits or no change Better adherence to oral Granules for reluctant toddlers
49
What happens if symptoms continue into step 3 of BTS/SIGN guidlines?
Add on LABA but keep open mind Additional add on therapies include increasing ICS and LTRA
50
Describe severe asthma in children?
Experimental medicine 50% psychological issues Less than 50% compliance issues Question the diagnosis Minority with genuine severe disease Role of biologics unproven
51
What are the two types of delivery systems for non acute asthma?
MDI (metred dose inhaler) with spacer Dry powder device
52
What 3 things make taking an MDI more effective?
Taking MDI with a spacer - 4x more lung deposition Shake inhaler between puffs Wash spacer monthly to reduce static
53
Explain dry powder devices?
Licensed in over 5s, under 8s cannot use them Achieve 20% lung deposition
54
What is the advantages of MDIs over nebulisers?
Quieter, quicker, valve mechanism. don't break down, portable and cheaper
55
What are some non-medical interventions that can help non acute asthma?
Stop tobacco smoke exposure Remove environmental triggers - pets, HDM had to eliminate

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