Paediatric Asthma Flashcards

1
Q

What is the one major thing to remember?

A

No wheeze

No asthma

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2
Q

What is the biggest trigger for asthma?

A

Common cold

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3
Q

What should you do is you suspect asthma?

A

Try an asthma treatment and see if there is improvement

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4
Q

What kind of condition is asthma?

A

Chronic

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5
Q

What is important about defining asthma?

A

It cannot really be defined.
It is more a concept
Other diagnoses must be excluded
It varies over time

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6
Q

What is asthma no longer?

A

A diagnosis of exclusion

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7
Q

What are the key words associated with asthma?

A
  • Wheeze
  • Variability
  • Respond to treatment
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8
Q

What similarities is there between asthma in children and asthma in adults?

A
  • Symptoms
  • Common
  • Same triggers
  • Same treatment
  • Same pathology
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9
Q

How does asthma differ between adults and children?

A
  • In children it is more common in boys and in adults it is more common in adults
  • Severity
  • Occupational asthma is uncommon in children
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10
Q

What is the epidemiology of asthma in children?

A
  • 1 million UK children
  • 100,000 Scottish children
  • 5% of UK children on inhaled steroids
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11
Q

What explains the similarities between paediatric and adult asthma?

A

Final common pathway

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12
Q

What are the multiple hits required for asthma?

A
  • Genes
  • Inherently abnormal lungs
  • Early onset atopy
  • Later exposures
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13
Q

What later exposures can affect asthma?

A
  • Rhinovirus
  • Exercise
  • Smoking
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14
Q

What inconsistences exist?

A
  • Transient vs persistent
  • Different severities
  • Different age at onset
  • Heterogeneity in response
  • Different triggers
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15
Q

What is critical to making an asthma diagnoses?

A

Taking a history

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16
Q

Why is examination usually unhelpful?

A

Unlikely to be wheezing at consultation due to the episodic nature of asthma

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17
Q

Why is there no asthma test?

A
  • Peak flow random number generator
  • Allergy tests irrelevant
  • Spirometry lacks specificity
  • Exhaled nitric oxide unproven
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18
Q

What does not exist in childhood asthma

A

Cough variant asthma

19
Q

What is not uncommon in childhood asthma?

A

Cough predominant asthma

20
Q

What is the mechanism for wheeze in asthma?

A
  • Bronchoconstriction
  • Airway wall thickening
  • Luminal secretions
21
Q

Why are children’s airways more likely to be musical?

A

They are smaller

22
Q

What is commonly reported as wheeze?

A
  • Rattle
  • Stertor
  • Stridor
23
Q

What is a sign or shortness of breath in asthma?

A

Sucking in of ribs with wheeze

24
Q

What is a cough related to asthma like?

A
  • Dry
  • Nocturnal
  • Exertional
25
Q

What can trigger asthma?

A
  • URTI
  • Exercise
  • Allergen
  • Cold air
  • Other such as emotion and menstruation
26
Q

Why does atopy not cause asthma?

A

They are secondary to the same process and URTI is the primary precipitant

27
Q

What personal history is common in asthmatics?

A
  • Eczema
  • Hay fever
  • Food allergies
28
Q

What has asthma and responds to asthma treatment?

A

Asthma

29
Q

What is the treatment for asthma?

A

Inhaled Corticosteroids for 2 months

30
Q

What is the ideal checklist for someone with asthma?

A

-Wheeze and shortness of breath at rest
-Multitrigger
-Sinusoidal
Atopy
-Parental asthma
-Responds to treatment

31
Q

What is often the differential diagnosis of asthma?

A
  • Viral induced wheeze
  • Foreign body
  • Cystic Fibrosis
  • Immune deficiency
  • Ciliary dyskinesia
  • Tracheo-bronchomalacia
  • Aspiration
  • Gastro-oesophageal reflux
32
Q

What is condition is said to be a different shade of asthma??

A

Viral induced wheeze

33
Q

What is infrequent episodic wheeze with a cold treated with?

A

Salbutamol

34
Q

When is a wheeze asthma?

A

A genuine wheeze which responds to treatment

35
Q

When is it unlikely to be asthma?

A

In a child under 18 months it is more likely to be infection

36
Q

What can an isolated cough be due to?

A
  • Bronchitis (2-3 year old, wet cough)
  • Pertussis (any age, fits, vomit, haematoma)
  • Habitual cough (8-12 year old, single loud cough
  • Trachheomalacia (life long loud cough)
  • Small print (CF, FB, DI, PCD)
37
Q

How does bronchitis present?

A
  • Loose rattly cough
  • Noisy breathing
  • Post-tussive vomit
  • Chest free of wheeze/creps
  • Child is VERY well but parents are worried
38
Q

What is the mechanism of bacterial bronchitis?

A
  • Disturbed mucocitliary clearance
  • RSV, adenovirus, rhinovirus
  • Haemophilus culture medium
  • 4+ week recovery
  • Infection secondary
39
Q

What is the natural history of bacterial b

A
  • Following URTI
  • Lasts 4 weeks
  • 60-80% respond
  • First Winter bad
  • Second Winter better
  • Third Winter fine
  • Pneumococcus/ H flu
40
Q

Why must there me a decision as the whether to treat bacterial bronchitis?

A
  • No treatment= self-limiting

- Treatment= risk of diarrhoea, effect on quality of life

41
Q

What is associated with pertussis?

A

Vomiting, colour change, petechiae, coughing fits

42
Q

Why is pertussis common?

A

Vaccination only reduces risk

43
Q

When is a preschool cough bacterial bronchitis?

A
  • No associated wheeze
  • Moist cough
  • Responds to antibiotics
44
Q

What is important to remember with asthmas?

A
  • No wheeze, no asthma
  • No asthma test
  • Confirm the diagnosis with trial of ICS
  • No lower age limit for diagnosing asthma