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Asthma in Children Flashcards

(51 cards)

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1
Q

What percentage of children have asthma?

A

15-20%

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2
Q

What factors contribute to the development of bronchial inflammation which leads to asthma?

A
  • Genetic predisposition
  • Atopy
  • Environmental triggers
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3
Q

What environmental triggers can cause asthma attacks?

A
  • URTI
  • Allergens - pollen, house dust mite, feathers, fur
  • Smoking
  • Cold air
  • Exercise
  • Emotional upset
  • Chemical irritant
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4
Q

What is the pathophysiology of asthma?

A

Bronchial inflammation

  • Oedema
  • Excessive mucus production
  • Infiltration of white cells (mast cells, eosinophils, neutrophils, lymphocytes)
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5
Q

What can asthma be related to?

A
  • Eczema
  • Hayfever
  • Food allergies
  • Exercise
  • Smoking
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6
Q

How does asthma present in a child?

A
  • Coughing
  • WHEEZE - recurrent
    • Worse at night
    • Obvious Triggers - precipitated by viral infections
    • Responds to treatment
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7
Q

What questions would you ask to assess the severity of asthma on presentation?

A
  • How frequent
  • Triggers
  • Sleep disturbance
  • Severity of interval symptoms
  • How much school have they missed
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8
Q

What are the long term signs of asthma in children?

A
  • Hyperinflation
  • Harrisons sulci - due to early onset of the disease
  • Generalised polyphonic wheeze
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9
Q

What factors can increase the risk of developing asthma?

A
  • Low brithweight
  • Family history
  • Bottle fed
  • Atopy
  • Male
  • Pollution
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10
Q

How would you investigate for asthma in a child?

A
  • History and examination - usually enough
  • Responds to treatment - 10-15% increase in PEFR
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11
Q

What would be a differential diagnosis for a wheezing child?

A
  • ASTHMA
  • Viral induced wheeze
  • Foreign body
  • Cystic fibrosis
  • Immune deficiency
  • Ciliary dyskinesia
  • Tracheo-bronchomalacia
  • Aspiration - GORD
  • Anaphylaxis
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12
Q

How would you go about assessing a childs control of their asthma?

A
  • Short acting beta agonists/week
  • Absence from school/nursery
  • Nocturnal symptoms/week
  • Exertional symptoms/week
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13
Q

How would you initiate a child with suspected asthma on treatment?

A

Monitored initiation of very low dose/low dose of ICS

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14
Q

What drugs would you use as a regular preventer in a child over the age of 5?

A

Very low dose ICS

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15
Q

What drugs would you use asa regular preventer in children under the age of 5?

A

LTRAs

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16
Q

If very low dose ICS were not controlling asthma well in a child over 5, what would you do next?

A

Add on therapy:

  • Add an inhaled LABA
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17
Q

If a child under the age of 5 was on LRTAs but their control was poor, what would you do next?

A

Add very low dose ICS

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18
Q

If there was no response ICS and an additional LABA, what would be your next step?

A

Remove the LABA and increase ICS dose to low dose

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19
Q

If a child who was on very low dose ICS and LABA showed some benefit, but still poor control, what could you change in their management?

A
  • Continue on LABA, and increase ICS dose

OR

  • Consider alternative therapy and maintain current doses - LTRA
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20
Q

What are SABAs?

A

Short acting beta2-agonists

Have an effect over 2-4 hours

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21
Q

Name some SABA medications

Study These Flashcards
A
  • Salbutamol
  • Terbutaline
22
Q

What are LABAs?

Study These Flashcards
A

Long acting Beta-agonists

Action last up to 12 hours

23
Q

What circumstances are SABAs used in?

Study These Flashcards
A
  • Increased symptoms
  • Acute asthma attacks
24
Q

How do beta agonists work?

Study These Flashcards
A

β2 agonists work by mimicking the effect of norepinephrine on β2 receptors. This produces sympathetic effects on tissues containing β2 receptors.

25
Name some LABA drugs
* **Salmeterol** * **Formoterol**
26
When are LABAs indicated?
* Exercise induced asthma * Chronic asthma management
27
What should always be considered as a cause of poorly controlled asthma?
Poor inhaler technique
28
What is ipratropium bromide?
***_Antimuscarinic bronchodilator_*** Muscarinic antagoinists competitively inhibit cholinergic receptors on bronchial smooth muscle Block action of acetylcholine on the nerve endings therefore inhibiting parasympathetic effect -\> dilatation of the airways.
29
How do inhaled corticosteroids work?
Reduce inflammation - often known as preventer
30
What are the side effects of inhaled corticosteroids?
None at low doses, however at high: * **Impaired growth** * **Adrenal suppression** * **Altered bone**
31
If a child was suffering from exercise induced asthma, how would you manage this?
SABA, and if that doesn't work progress to LABA + ICS
32
What clinical features suggest a child is having an asthma attack?
* **Wheeze** * **Tachypnoea** * **Increasing tachycardia** * **Accessory muscle use** * **Inability to speak**
33
What would indicate moderate acute asthma?
* **O2 saturations \>92%** * **Peak flow \>50% predicted** * **No clinical features of severe asthma**
34
What would indicate severe acute asthma?
* **Too breathless to talk/feed** * **Accessory muscle use** * **O2 saturations \<92%** * **RR -** \>30/min (over 5), \>50/min (2-5) * **Pulse** - \> 130/min (2-5), \>120/min (over 5) * **Peak flow** - \< 50% (if you can get it)
35
What clinically would indicate life-threatening asthma attack?
* **Slient chest** * **Poor respiratory effort** * **Altered consciousness** * **Cyanosis** * **Oxygen saturations \<92%** * **Peak flow \< 30% predicted**
36
How would you assess the severity of an asthma attack in a child?
* **Ability to talk** * **Breathing** - tachypnoea, recession, wheeze, silent chest * **Pulse** * **Level of consiousness** * **Cyanosis** * **PEFR** * **O2 saturations**
37
How would you treat someone with an acute asthma attack?
* **SABA via large volume spacer** - 2-4 puffs, increasing by 2 puffs every 2 minutes to 10 puffs * **Consider Oral prednisolone**
38
How would you manage a child with severe asthma attack?
* **High flow oxygen** - 100% via nasal prongs/face mask * **SABA** - inhaler or nebulised * **Oral prednisolone/IV hydrocortisone** * **Nebulised ipratropium bromide**
39
How would you treat a child with life threatening asthma?
***_Call for HELP!!!! and alert ICU_*** * **High flow oxygen** + **Neb. SABA + Neb. Ipra. Bromide** * **IV hydrocortisone** * **IV Amynophilline** * **IV Magnesium sulfate** * **Intubation and ventilation**
40
What would you do if a child with severe/life-threatening asthma was not responding to treatment?
* **Move to HDU/ITU** * **Consider CXR + Blood gases** * **Intubate and ventilate**
41
What should you consider using if IV amynophilline or salbutamol?
Monitor potassium shifts * **ECG** * **U+Es**
42
What is the lung deposition of inhaled drug without a spacer?
= 5%
43
What percentage of an inhaled drug is deposited in the lung when using in combination with a spacer?
= 20%
44
What are LTRAs?
***_Leukotriene Receptor Antagonists_*** Block the effects of leukotrienes at the LTC4, LTD4 and LTE4 receptors in the airways, decreasing both the early and late responses to inhaled allergens.
45
What are different modes of delivering inhaled drugs?
* **pMDI** * **Breat actuated metered dose inhaler** * **Dry Powder inhaler** * **Nebuliser**
46
What is the recommended age group for pMDIs?
* **0-2 years** - spacer + facemask * **\>2 years** - spacer alone
47
What age are breath actuated metered dose inhalers recommended for?
6+
48
What is the name of the main LTRA used in asthma?
Montelukast
49
What common problems can occur when trying to manage asthma?
* **POOR INHALER TECHNIQUE** * **Inadequate perception/planning for attacks** * **Too much inhaled steroid** * **Not recognising nocturnal waking as a sign of dangerous asthma**
50
What lifestyle changes can be made to try to improve asthma symptoms?
* **Smoking cessation** - self and family * **Removal of environmental triggers**
51
What signs would you see on examination in a child with asthma?
* **Reduced breathing but hyperinflated chest** * **Use of accessory muscles** * **Chest wall retraction on breathing** * **Hyper-resonant chest** * **Wheeze**

Paediatrics (27 decks)

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