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Paediatric Asthma PowerPoint Presentation

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Description : This medical presentation titled ""Paediatric Asthma"" tells us what childhood asthma is, its pathology, signs and symptoms, Diagnosis, principles of asthma management (Self management, Pharmacotherapy, Assessing control).

Tags : Pediatric Asthma, Allergy, Autoimmune Diseases, wheezing, breathlessness, chest tightness, coughing, Asthma Inflammation, Cells, Mediators, Genes predisposing, atopy, Allergens, Domestic mites, furred animals, cockroach allergens, fungi, molds, yeasts, Pollens, fungi, molds, yeasts, Infections, predominantly viral, Occupational sensitizers, Tobacco smoke, Passive smoking, Active smoking, Indoor, Outdoor air pollution, Diet, Risk factors, children, Respiratory infections, Symptomatology, features, Diagnosis, Co-morbidities, pathology, signs, symptoms, Diagnosis, principles, Self management, Pharmacotherapy, Assessing control

Published on : Apr 24, 2021 | Views : 3261 | Downloads : 3

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Slide 1-

Paediatric Asthma Dr Rossa Brugha Clinical Research Fellow April 2010
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Paediatric asthma What is asthma in childhood? Pathology, signs and symptoms Diagnosis Principles of asthma management Self management Pharmacotherapy Assessing control What’s new
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Asthma vs preschool wheeze Asthma Above age 5 Approx 1 in 11 children Inflammatory condition Responds to inhaled corticosteroids Preschool wheeze Age 1-5 Approx 1 in 3 children ‘Episodic viral’ wheeze Wheeze only with viral infections No evidence for ICS ‘Multi-trigger’ wheeze URTIs plus other triggers eg exercise, smoke, allergens Only give oral prednisolone in subgroup of those requiring admission See: Bush A, Grigg J, Saglani S. Managing wheeze in preschool children. BMJ 2014; 348
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What is Asthma? A clinical diagnosis There is no agreed definition, no known cause Genetic susceptibility plus environmental trigger: 1st degree relative increases risk Identical environments in siblings with and without asthma Time course/“double hit” of atopic sensitization and viral infection eg hRV3; 1st year of life is crucial
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Clinical features that increase the probability of asthma More than one of the following symptoms: Wheeze, cough, DIB, chest tightness, particularly if symptoms: are frequent and recurrent are worse at night and in the early morning occur in response to, or are worse after, exercise or other triggers, such as exposure to pets, cold, damp air, or with emotions/laughter
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Personal history of atopic disorder Family history of atopic disorder and/or asthma Widespread wheeze heard on auscultation History of improvement in symptoms or lung function in response to adequate therapy Clinical features that increase the probability of asthma
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Clinical features that lower the probability of asthma Symptoms with colds only, with no interval symptoms Isolated cough in the absence of wheeze or difficulty breathing History of moist cough Prominent dizziness, light-headedness, peripheral tingling
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Clinical features that lower the probability of asthma Repeatedly normal physical examination of chest when symptomatic Normal peak expiratory flow (PEF) or spirometry when symptomatic No response to a trial of asthma therapy Clinical features pointing to alternative diagnosis
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Airway pathology in asthma The hallmark of asthma is chronic airway inflammation From: Bradding, P., Walls, A.F. & Holgate, S.T. (2006). The role of the mast cell in the pathophysiology of asthma. J Allergy Clin Immunol 117, 1277–84
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Airway pathology in asthma
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Signs and symptoms The result of airway inflammation is airway narrowing
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Self management Avoid triggers Air pollution Passive (active) smoking Aeroallergens when/if possible Healthy diet Studies in adults and children have shown that a high intake of fresh fruit and vegetables is associated with fewer asthma symptoms and better lung function
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Self management Exercise Warm up and warm down Use bronchodilator pre-exercise Good evidence that exercise helps asthma Complementary treatments Buteyko breathing (a technique to control hyperventilation) has been shown to reduce symptoms
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Pharmacotherapy Steroids Montelukast Monoclonal anti-IgE (omalizumab, Xolair) Lebrikizumab: anti IL-13 Mepolizumab: anti IL-5 Pascolizumab: anti IL-4
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Management of chronic asthma
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Asthma control test During the past 4 weeks: How often did your asthma prevent you from getting as much done at work, school or home? How often have you had shortness of breath? How often did your asthma (wheezing, coughing, chest tightness, shortness of breath) wake you up? How often have you used your reliever inhaler? How would you rate your asthma control ?
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Comorbidities Around 50% with asthma will have atopy Eczema Rhinitis Hayfever Antigen crossing via these sites can persistently sensitise the immune system Important to optimise epithelial health Barriers (emollient) Immunomodulators (topical steroid) Symptom control (antihistamines)
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What’s in the pipeline Phenotyping asthma Via SNPs eg leukotrienes and ALOX-5 “Urine dip” for asthma By sputum leucocytes By exhaled breath cytokine pattern (Th1, Th2, Th17) Predicting exacerbations/inflammometry FeNO (probably not in children) Sputum eosinophil count (probably not in children) ACT score Peak flow fractals
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Why phenotype? All that wheezes is not asthma Consider the approach to management of other chronic inflammatory conditions in childhood Joint arthropathies Inflammatory bowel disease
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Asthma Review: Checklist The right diagnosis Check symptom control (ACT) Ask about and address smoking (child and parent) The right treatment at the right time (step-wise) Before initiating a new drug/step: check compliance with existing therapies, inhaler technique and try to eliminate trigger factors. Minimise side effects from treatment (i.e. growth if on high dose ICS) The right inhaler, correct technique Give inhaler training, ensure correct technique before writing prescription
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The gold standard is MDI + spacer Give Asthma education (repetition, reinforcement, signpost/give resources) All children should have an Asthma Plan Promote self-management Compliance Need regular review Annual review Review at 48-72 hrs and 30 days post exacerbation/admission Asthma Review: Checklist
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NICE Quality standards QS25 Statement 1. People with newly diagnosed asthma are diagnosed in accordance with BTS/SIGN guidance. Statement 2. Adults with new onset asthma are assessed for occupational causes. Statement 3. People with asthma receive a written personalised action plan. Statement 4. People with asthma are given specific training and assessment in inhaler technique before starting any new inhaler treatment. Statement 5. People with asthma receive a structured review at least annually. Statement 6. People with asthma who present with respiratory symptoms receive an assessment of their asthma control.
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NICE Quality Standards QS25 Statement 7. People with asthma who present with an exacerbation of their symptoms receive an objective measurement of severity at the time of presentation. Statement 8. People aged 5 years or older presenting to a healthcare professional with a severe or life-threatening acute exacerbation of asthma receive oral or intravenous steroids within 1 hour of presentation. Statement 9. People admitted to hospital with an acute exacerbation of asthma have a structured review by a member of a specialist respiratory team before discharge. Statement 10. People who received treatment in hospital or through out-of-hours services for an acute exacerbation of asthma are followed up by their own GP practice within 2 working days of treatment. Statement 11. People with difficult asthma are offered an assessment by a multidisciplinary difficult asthma service.
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Useful learning resources Acute breathing difficulties: http://abd.ocbmedia.com/home/ Spotting the Sick child; https://www.spottingthesickchild.com/ Adult & Paed case studies: http://real.educationforhealth.org/ Itchy Sneezy Wheezy: http://www.itchysneezywheezy.co.uk/ Asthma UK http://www.asthma.org.uk/
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Summary Asthma is very common Large disease burden Morbidity & mortality Regular asthma review Assess control Assess technique Assess understanding, compliance/concordance Question the diagnosis