paediatric asthma features

Question 1

4 key points

Answer 1

no wheeze = no asthma
tests may help confirm decision
if QOL affected, confirm diagnosis w/ trial of inhaled corticosteriods
if QOL not affected, wait and see

Question 2

what is asthma

Answer 2

chronic 
wheeze, cough SOB
multiple triggers
variable/reversible 
responds to asthma treatment

Question 3

inconsistencies

Answer 3

transient vs persistent 
viral induced wheeze vs asthma
different severities
heterogeneity in response
different triggers

Question 4

causes

Answer 4

host reponse to environment 
infection is important 
abnormal physiology before symptoms
genes 
allergy

Question 5

genetic causes

Answer 5

30-80% of causation
~10 variants making modest contribution
ADAM33, ORMDL3
interact w/ environment

Question 6

allergic causes

Answer 6

less likely
1y epithelial abnormality
eczema, asthma, allergy
allergy fuels eczema/asthma etc

Question 7

epidemiology

Answer 7

1.1mln children in UK
110 000 in scotland
5% of children in UK on ICS

Question 8

when is it asthma

Answer 8

Hx is the most important tool
there are lots of lower resp tract symptoms that turn out not to be asthma - watch and wait
no diagnostic test in children

Question 9

tests used to confirm asthma

Answer 9

spirometry
bronchodilator response
exhaled NO
peak flow

Question 10

Hx

Answer 10

parental Hx of asthma

PMH of eczema, hayfever, food allergies

Question 11

symptoms

Answer 11

wheeze is a must have (check it actually is a wheeze)
cough predominant asthma isnt uncommon
SOB at rest: significant resp difficulty (<30% lung function), airway obstruction, sucking in of ribs w/ wheeze
dry cough - nocturnal, exertional

Question 12

response to treatment

Answer 12

if it responds to treatment it is likely to be asthma

ICS for 2mths

Question 13

cons of treatment trial

Answer 13

cost
hassle
0.5-1cm height loss
oral thrush

Question 14

pros of treatment trial

Answer 14

aids diagnosis
symptoms respond
increased QOL
reduced risk of attacks

Question 15

when is it not asthma

Answer 15

<18 m/o - most likely infection
>5 y/o - most likely asthma

if it sounds like asthma and responds to asthma treatment, it is asthma regardless of age

Question 16

differential diagnosis for asthma

onset <5y/o

Answer 16

congenital 
CF
PCD - Primary ciliary dyskinesia
bronchitis
foreign body

Question 17

differential diagnosis for asthma

onset >5y/o

Answer 17

dysfunctional breathing
vocal cord dysfunction
habitual cough
pertussis

Question 18

asthma vs viral induced wheeze

Answer 18

separate conditions
mostly occurs in pre-school children
should be treated

Question 19

pre school cough

Answer 19

associated wheeze –> (Y) wheeze algorithm
–> (N) is it moist/dry
dry –> wait and see
moist –> red flags (age <6m/o or >4y/o, no resolution, SOB episodes, other conditions)

if Y to red flags –> bronchiectasis
if N to red flags –> bacterial bronchitis or other (pertussis, habitual cough, CF, prev pneumonia, tracheomalacia)