Asthma in Children

Question 1

How is asthma distinguished from COPD?

Answer 1

By its variability

Question 2

Major symptoms of asthma?

Answer 2

Dyspnoea
Wheeze
Cough

Question 3

Pathology of asthma

Answer 3

Hyperresponsiveness - histologically, there is mucosal oedema in the bronchi; infiltration of the bronchial mucosa or submucosa with inflammatory cells, especially eosinophils, and shedding of epithelium and obstruction of peripheral airways with mucous

Question 4

Simalilarites with asthma in adults

Answer 4

Symptoms
It is common 
Same triggers 
Same treatment 
Same Pathology

Question 5

Differences with asthma in adults

Answer 5

M > F in children, but F > M in adulthood
Severe asthma
Occupation asthma uncommon

Question 6

What are the multiple hits in the aetiology of asthma

Answer 6

Genes
Abnormal lungs (if have gene but normal lungs -> no asthma)
Early onset atopy 
Later exposures:
-Rhinovirus
-Exercise
-Smoking

Question 7

Cardinal signs of asthma

Answer 7

Wheeze - produces a soft expiratory polyphonic sound
SOB at rest - severe obstruction
Dry cough - may be nocturnal or exertional
Parental asthma
Responds to treatment (ICS)

Question 8

What is the mechanism of a wheeze?

Answer 8

Bornchoconstriction, airway wall thickened and luminal secretions all narrow the airway, and children airways are smaller so more likely to be musical

Question 9

Name 5 triggers

Answer 9

URTI (rhinovirus)
Exercise 
Allergen
Cold air 
Other - emotion, menstruation

Question 10

When is it most likely not asthma?

Answer 10

< 18months - usually infection
> 5yrs - most likely asthma

But if it sounds like asthma and responds to asthma treatment then it is asthma regardless of ages

Question 11

What to do if you suspect asthma but uncertain?

Answer 11

Asthma treatment of ICS for 2 months and see if it responds

Question 12

What guideline are available?

Answer 12

BTS/SIGN - UK, Australia and EU
GINA - America
NICE - UK

Question 13

Aims of treatment

Answer 13

Minimal symptoms during day and night
Minimal need for reliever medication
No attacks (exacerbations)
No limitation of physical activity

Question 14

What is the acronym for measuring control of asthma?

Answer 14

SANE

S short acting B agonist use per week
A absence school/nursery
N nocturnal symptoms per week
E excertional symptoms per week

Question 15

What does the A in SANE indicate?

Answer 15

Poor quality of life

Question 16

What does the N in SANE indicate?

Answer 16

Poor control of asthma if experiencing nocturnal symptoms more than once a week

Question 17

What does the S in SANE indicate?

Answer 17

If require deliver medication (SABA) more than 3 times per week then shows poor control

Question 18

What to do if well controlled?

Answer 18

With no charge or reduce

Question 19

What to do if not well controlled?

Answer 19

Check:
Compliance 
Taking treatment correctly
That they have asthma 
Need to increase dose

Question 20

What is the initial step of the step up step down approach?

Answer 20

Start on low dose ICS - even severe may respond to minimal treatment

Review after 2 months

Question 21

Contrast in medication with adults

Answer 21

Max dose ICS 800mg
No oral B2 tablet
LTRA first line preventer in <5s

Question 22

Step 1 of treatment in children

Answer 22

Inhaled SABA - spacer/MDI or DPI

Question 23

Step 2 of treatment in children

Answer 23

Use of regular preventer - Start very low dose of ICS (or LTRA in <5s)

Question 24

When to step up to step 2 in treatment?

Answer 24

When using inhaled B2 agonists three times a weeks or more (reliever)
Symptomatic three times a week or more
Waking one night a week

Question 25

Step 3 of treatment in children

Answer 25

Add on regular preventer - LABA Additional add on therapies: - Increased ics - LTRA

Question 26

Benefits of ICS

Answer 26

Useful for diagnosis Very effective Very safe

Question 27

Side effects of ICS

Answer 27

Height suppression May be: Oral candidiasis Adenocortical suppression

Question 28

What are two rules for LABA use?

Answer 28

Do not use without ICS!!! | Use as a fixed dose inhaler

Question 29

Two types of delivery systems?

Answer 29

MDI/spacer | dry powder device

Question 30

Points about dry powder devices to remember

Answer 30

Under 8s cannot use them | Achieve 20% lung deposition

Question 31

Points about spacers to remember

Answer 31

20% lung deposition Shake between puffs Wash monthly to reduce status Increases delivery but 100%

Question 32

Non-pharmological management

Answer 32

Stop tobacco smoke exposure | Remove environmental triggers (pets)

Question 33

Treatment of mild acute asthma

Answer 33

SABA via spacer | SABA via spacer + prednisolone

Question 34

Treatment of moderate acute asthma

Answer 34

SABA via nebuliser + prednisolone | SABA + ipratropium via nebuliser + pred

Question 35

Treatment of severe acute asthma

Answer 35

``` IV salbutamol IV aminophylline IV magnesium IV hydrocortisone Intubate and ventilate ```

Question 36

Use of different steroids

Answer 36

Chronic/maintenance = inhaled steroids | Acute treatment = oral steroids

Question 37

Signs of acute asthma

Answer 37

``` RR Work of breathing HR O2 saturation Ability to complete sentences Confusion due to hypoxia Air entry ```