LRTI

Question 1

What is bronchitis?

Answer 1

inflammation of the lining of the bronchial tubes
- Rare in children
- Viral infection
- Antibiotics not effective
- Confused with asthma

Question 2

What is asthma?

Answer 2

a condition in which a persons airways become inflamed, narrow and swell and produce extra mucus which makes it difficult to breathe
- Common in children
- Familial
- Associated with eczema
- Confused with bronchitis

Question 3

When is asthma diagnosed?

Answer 3

> 3 years and nearly all by the age of 7 years

Question 4

What is the true definition of asthma?

Answer 4

Recurrent and REVERSIBLE bronchospasms

Question 5

Clinical features of asthma?

Answer 5

Recurrent cough, worse at night

Question 6

Historical points that may suggest that the child’s asthma is triggered by allergens?

Answer 6

1. Seasonal nature: pollen
2. Worse when exposed to a pet: Animal dander
3. Worse when bed is made or carpets/furnisher is dusted: house dust mites
4. Worse in damp house holds: moulds

Question 7

Pathophysiology of asthma?

Answer 7

Trigger > Exacerbations > bronchi mucus, oedema, spasms > Bronchiole obstruction > air trapping OR collapse

Question 8

Classification of asthma?
How it is classified?

Answer 8

Mild, Moderate, and Severe
- classified on frequency and Impact on activity

Question 9

What are acute asthma exacerbations?

Answer 9

episodes of worsening asthma symptoms and lung function
- can be the presenting manifestation of asthma or occur in patients with a known asthma diagnosis in response to a trigger e.g. viral upper respiratory infection, allergen, air pollution etc

Question 10

Treatment of acute exacerbation of asthma?

Answer 10

1. bronchodialators
2. steroids
   - Goal is to stop the spasms and reduce inflammation

Question 11

What bronchodialators are used in asthma?

Answer 11

1. Mild: Salbutamol MDI 2-4 puffs
2. Mod-Severe: Salbutamol nebuliser

Question 12

What steroids are used in asthma?

Answer 12

Oral Prednisolone or IV Dexamethasone

Question 13

If asthma is severe with impending death what do you use to treat?

Answer 13

1. aminophyline
2. magnesium
   Note: aminophyline has a narrow therapeutic window necessitating close monitoring

Question 14

Why is inhaled salbutamol preferred?

Answer 14

because adverse effects—tremor, prolonged tachycardia, and irritability—are less

Question 15

What is the natural progression of an asthma attack?

Answer 15

Cough > Wheezing > Tachpynea > ”silent chest” > Lethargy > Hypocapnia > “Normalizing” of respiratory rate > Respiratory failure > Death

Question 16

Why should you beware of an asthmatic child that looks like they are getting better?

Answer 16

are they getting better or getting tired?

Question 17

What is status asthmaticus?

Answer 17

is an acute exacerbation of asthma that does not respond adequately to therapeutic measures and may require hospitalization

Question 18

Treatment of mild asthma?

Answer 18

Salbutamol rescue Inhaler as needed
- teach guardian to identify triggers

Question 19

Treatment of moderate asthma?

Answer 19

Long acting bronchodilator (e.g., Salmeterol) and rescue inhaler

Question 20

Treatment of severe asthma?

Answer 20

Daily inhaled steroids, long acting bronchodilator, and rescue inhaler
- guardian needs “emergency plan”

Question 21

Management of asthma?

Answer 21

Control allergies (dust, mold, cockroaches, etc)
Note: Oral salbutamol is of little use and should NOT be prescribed for moderate or severe asthmatics

Question 22

What is bronchiolitis?

Answer 22

• ARI primarily in infants (3-6 months)
• Infection and inflammation of the bronchioles.
• Highly contagious (contact)

Question 23

Aetiology of bronchiolitis?

Answer 23

viral: RSV, Adenovirus, Influenza, Parainfluenza, Human metapneumovirus