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Year Three - Paediatrics > Chronic Asthma > Flashcards

Chronic Asthma Flashcards

(68 cards)

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1
Q

What is asthma?

A

It is a chronic inflammatory airway disease
leading to variable airway obstruction

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2
Q

What hypersensitivity reaction is associated with asthma?

A

Type 1

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3
Q

What is the pathophyiosology of asthma?

A

In asthma patients, the smooth muscle within the airways is hypersensitive, responding to stimuli by constricting and therefore causing airflow obstruction

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4
Q

What is the key characteristic feature of the bronchoconstrcition associated with asthma?

A

It is reversible

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5
Q

What are the eight risk factors of asthma?

A

Atopy Personal/Family History

Antenatal Factors

Low Birth Weight

Bottle Feeding

Obesity

Allergen Exposure

Air Pollution

Hygiene Hypothesis

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6
Q

What is atopy?

A

It is defined as the body’s predisposition to develop an antibody called immunoglobulin E in response to environmental allergens

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7
Q

What is more influential - maternal or paternal atopy?

A

Maternal

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8
Q

What are the three main atopic conditions?

A

Asthma

Atopic dermatitis (eczema)

Allergic rhinitis (hayfever)

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9
Q

What two genes are associated with asthma?

A

ADAM33

ORMDL3

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10
Q

What two antenatal risk factors are associated with asthma?

A

Maternal Smoking

Viral Infection

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11
Q

What antenatal viral infection is most commonly associated with asthma?

A

RSV

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12
Q

What is the hygiene hypothesis?

A

It refers to reduced exposure to infectious agents in childhood resulting in abnormal development of the immune system - specifically resulting in a Th2 predominant response

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13
Q

What are the three clinical features of asthma?

A

Dry Cough

Dyspnoea

Bilateral Expiratory Wheeze

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14
Q

What are the two characteristics of the clinical features associated with asthma?

A

Episodic

Diurnal variability - worse in the early morning and night

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15
Q

List seven common triggers of asthma

A

Infection

Dust

Exercise

Animals

Smoking

Cold air

Food allergens

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16
Q

What three food allergens commonly trigger asthma?

A

Peanuts

Shellfish

Eggs

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17
Q

In most cases how is asthma diagnosed?

A

Clinically

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18
Q

What four investigations can be used to confirm a diagnosis of asthma?

A

Spirometry

Peak Flow Meter

Fractional Exhaled Nitric Oxide (FeNO)

Direct Bronchial Challenge Test

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19
Q

What two things need to be proven through investigations, in order to confirm a diagnosis of asthma?

A

Airflow obstruction

Airflow obstruction reversibility

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20
Q

What is spirometry?

A

It is an investigation that measures the volume and flow of air during exhalation and inhalation

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21
Q

What three metrics are obtained from spirometry?

A

Forced Expiratory Volume 1 (FEV1)

Forced Vital Capacity (FVC)

FEV1 : FVC

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22
Q

What is FEV1?

A

It is defined as the volume that has been exhaled at the end of the first second of forced expiration

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23
Q

What is FVC?

A

It is defined as the volume that has been exhaled after a maximal expiration, following a full inspiration

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24
Q

In which age group can we conduct spirometry in?

A

> 5 yrs old

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25
What three spirometry results indicate a diagnosis of asthma?
Reduced FEV1 Normal FVC FEV1 : FVC < 70%
26
Following abnormal spirometry results, what should be tested?
We test the reversibility of airflow obstruction
27
In what two ways can we test reversibility of airflow obstruction with spirometry?
Bronchodilator response Corticosteroid response
28
Describe how bronchodilators can be used to test the reversibility of airflow obstruction in spirometry
We administer 400ug inhaled salbutamol or 2.5-5mg nebulised salbutamol We conduct spirometry tests 15 minutes following administration The results are deemed to demonstrate reversibility when FEV1 > 400ml
29
Describe how corticosteroids can be used to test the reversibility of airflow obstruction in spirometry
We administer 30mg oral prednisolone for a period of 14 days or 500mcg inhaled beclomethasone for a period of 6 weeks The results are deemed to demonstrate reversibility when FEV1 > 400ml
30
What are peak flow meter tests?
They involve the patients blowing as hard and as fast as they can into a small handheld device This measures the rate at which air is exhaled from the lungs, obtaining a peak expiratory flow (PEF) score in litres of air breathed out per minute
31
How can peak flow meter tests be used to diagnose asthma?
We ask patients to conduct peak flow meter readings at home twice daily for a period of 2 – 4 weeks These readings are then plotted upon a chart, which incorporate the patient’s age, height and sex
32
What three peak flow meter test results indicate asthma?
Morning/nocturnal dips A gradual decline of results over A variability of results greater than 20% on more than 3 consecutive days of the week
33
What are FeNO tests?
They measure the level of nitric oxide in the exhaled breath, providing information about the eosinophilic inflammation in the lungs
34
How do FeNo test results provide information about eosinophilic inflammation in the lungs?
This is due to the fact that nitric oxide is produced by inducible nitric oxide synthase (iNOS), with levels increasing in inflammatory cells – particularly eosinophils Therefore, the level of nitric oxide correlated with the levels of inflammation.
35
What is a direct bronchial challenge test?
It involves gradually increasing doses of medications that can irritate the airways to precipitate airway constriction It therefore measures hypersensitivity of the airways
36
What three medications can be used in direct bronchial challenge tests?
Histamine Methacholine Mannitol
37
What direct bronchial challenge results indicate a diagnosis of asthma?
There are reduced medication doses required to precipitate constriction
38
At what age do children need to be before they can obtain a diagnosis of asthma?
2-3 yrs old
39
What are the five pharmacological management options of asthma?
Short Acting Beta-2 Agonists (SABA) Inhaled Corticosteroids (ICS) Long Acting Beta-2 Agonists (LABA) Leukotriene Receptor Antagonists (LTRA) Maintenance & Reliever Therapy (MART)
40
Name two SABA inhalers
Salbutamol Terbutaline
41
Salbutamol is what inhaler colour?
Blue
42
When are SABA inhalers used to treat asthma?
They are the first line pharmacological option
43
What is another term for SABA inhalers? Why?
Reliever inhalers They are used to relieve acute asthma features as required
44
What is the mechanism of action of SABA inhalers?
The adrenalin in these inhalers works to relax the smooth muscles within the airways
45
What is the main side effect of SABA?
Tremor
46
Name two ICS inhalers
Beclomethasone dipropionate Fluticasone propionate
47
Beclomethasone dipropionate is what colour of inhaler?
Brown
48
Fluticasone propionate is what colour of inhaler?
Purple
49
When are ICS inhalers used to treat asthma?
They are the second line pharmacological option
50
What is another term for ICS inhalers? Why?
Preventor inhalers They should be administered by the patient every day regardless of whether the patient experiences asthma features
51
At what frequency should ICS inhalers be initially administered?
Twice daily
52
What are the two side effects of ICS inhalers?
Oral candidiasis Stunted growth
53
Name a LABA inhaler
Salmeterol
54
When are LABA inhalers used to treat asthma?
They are the fourth line pharmacological option
55
What is another term for LABA inhalers? Why?
Preventer inhalers They should be administered by the patient every day regardless of whether the patient experiences asthma features
56
What is the mechanism of action of LABA?
The adrenalin in these inhalers works to relax the smooth muscles within the airways
57
Name an LTRA
Oral montelekast
58
When are LTRAs used to treat asthma?
They are the third line pharmacological option
59
What is the mechanism of action of LTRAs?
Leukotrienes are produced by the immune system to cause inflammation, bronchoconstriction and mucus secretion LTRAs inhibit leukotrienes and therefore prevent its effects
60
What is MART?
It is a form of combined inhaled corticosteroid and long acting beta-2 agonist treatment in a single inhaler
61
How do we administer MART?
It can be administered for both daily maintenance therapy and to relieve acute asthma features as required
62
When do we administer MART?
It is only recommended in individuals who have poorly controlled asthma
63
What are the four stepwise management options for asthma in < 5 yrs old?
SABA Inhaler As Required Add An ICS Inhaler OR Oral LTRA Add The Other Option From Step Two Specialist Referral
64
What are the five stepwise management options for asthma in children between 5 - 12 yrs old?
SABA Inhaler As Required Add An ICS Inhaler Add An Oral LTRA OR LABA Inhaler Titrate Up The ICS Inhaler Dose Or Add The Other Option From Step Three Specialist Referral
65
What are the five stepwise management options for asthma > 12 yrs old?
SABA Inhaler As Required Add An ICS Inhaler OR MART Inhaler Add A LABA Inhaler Titrate Up The ICS Inhaler Dose Or Add An Oral LTRA Specialist Referral
66
How do we monitor the efficiency of asthma management?
It is based upon the patient’s clinical history, rather than a specific investigation For example, in patients who are requiring more than three doses of their SABA inhaler per week, we would recommend that their medication is reviewed accordingly
67
When do we recommend that paediatric asthma patients are not started on inhalers? Why?
Easter This is due to their return back to school at this time resulting in a lot of children falling ill This means that it can be difficult to tell whether their treatment is ineffective or they are ill
68
What complication occurs when patients have a poor inhaler technique?
Oral candidiasis

Year Three - Paediatrics (29 decks)

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