What is the most common chronic condition in kids?
Asthma
What fraction of kids in the UK have asthma?
1/11
What is the Pathophysiology of Asthma in kids? (7 steps)
- Allergen exposure
- Dendritic cells present allergen to Th2 type T cells
- Th2 type T cells release Cytokines
- Cytokines –> Inflamm + Bronchoconstriction
- Cytokines activate Humoral immune system
- Proliferation of: Mast cells + Eosinophils + Dendritic cells
- Mast cells release Histamine
What are the RF for Asthma in kids? (6 things)
- FHx
- Parental smoking
- Hx of Viral bronchiolitis
- Dx of Atopic dermatitis
- Prematurity
- Low birth weight
What are the Typical Triggers for Asthma in kids? (7 things)
- Dust (house dust mites)
- Animals
- Cold air
- Smoke
- Exercise
- Food (peanuts / shellfish / eggs)
- Beta blockers
How can Beta blockers trigger Asthma in kids?
They prevent bronchodilatory fx of Catecholamines on airway
What are the adjective of the CF of Asthma in kids? (3 things)
- Episodic CF w intermittent exacerbations
- Diurnal variability (worse @ night + early morning)
- CF improve w bronchodilators
What are the CF of Asthma in kids? (3 things)
- Dry cough
- Wheeze
- SOB
What things in the Hx point towards a Dx of Asthma in kids? (2 things)
- Hx of other atopic conditions (eczema, hayfever, food allergies)
- FHx of atopy
What CF point towards a Dx OTHER than Asthma in kids? (5 things)
- Wheeze only associated w cough / colds
- Unilateral wheeze
- Isolated / productive cough
- Normal @ exam
- CF don’t improve w bronchodilators
What does a Wheeze only associated w cough / colds suggest the Dx is?
Viral induced wheeze
What does a Unilateral wheeze suggest the Dx could be? (3 things)
- Focal lesion
- Inhaled foreign body
- Infection
What is the Dx of Asthma in kids made on?
Clinically
Before what age are kids not Dx with Asthma until?
2-3 years old
What does a GP do when there is LOW probability of Asthma but child = symptomatic?
Refer to specialist for Dx
What does a GP do when there is MID / HIGH probability of Asthma? (2 steps)
- Trial Tx
- If Tx improves CF –> Dx
What investigations can you do for sus Asthma in kids? (4 things)
- Spirometry (in kids over 5)
- Direct bronchial challenge test w Histamine / Metacholine
- Fractional exhaled Nitric Oxide (FeNO)
- Peak flow diary (few times a day for 2 weeks)
Why is Spirometry not the best investigation for Asthma in kids?
Usually normal in between exacerbations
Why is Direct bronchial challenge test w Histamine / Metacholine not the best investigation for Asthma in kids?
Mild asthma kids will give NEGATIVE result in 50% of cases
What is the aim of Mx of Asthma in kids?
Achieve “good symptom control”
What does achieving “good symptom control” mean for Mx of Asthma with kids? (7 things)
- Full school attendance
- No limitation of daily activities
- No sleep disturbance
- Less than 2x per week daytime CF
- Less than 2x per week using Salbutamol
- No exacerbations
- Maintaining normal lung function
What is the Step wise approach for Mx of Asthma in kids? (6 things)
- Step 1: SABA (Salbutamol) (PRN)
- Step 2: Regular Low ICS
- Step 3: LABA (Salmeterol)
- Step 4: Medium ICS + 1 of: LTRA (Montelukast) / Theophylline
- Step 5: High ICS
- Step 6: Refer to specialist (may req daily oral steroids)
(steps add on)
What is the main complication of Asthma?
Asthma attack (exacerbation)
What are the signs of a severe asthma attack? (4 things)
- Inability to complete sentences
- Pulse over 110bpm
- Resp rate over 25 / min
- Peak Expiratory Flow (PEF) 33-50%
