asthma in the child Dr A Rahman GPST3

“Reversible airway disease characterised by breathlessness and wheeze, secondary to inflammation and bronchospasm” – Me

Pathophysiology Hypersensitive bronchial epithelium in susceptible patients (Over)react to stimuli - allergen, dust, smoke, virus, exercise Bronchospasm, inflammation, excess mucus production Obstructive narrowing of airways

presentation Wheeze Breathlessness - “short of breath,” “fast breathing,” “difficulty in breathing” Chest tightness Cough

history Viral URTI/coryzal symptoms Exercise Change in weather Smoke Damp Atopy - eczema/hay fever Allergies Family history

On examination Increased respiratory rate Decreased SpO2 Accessory muscle use Sternal/intercostal recessions Tracheal tug Agitated/unresponsive Cyanosis Wheeze Silent chest

Acute asthma moderate severe life threatening SpO2 > 92% PEF > 50% best or predicted PEF 33-50% best or predicted PEF < 33% best or predicted No clinical features of severe asthma Can't complete sentences in one breath or too breathless to talk or feed Silent chest Poor respiratory effort HR > 125 or 140 RR > 30 or 40 Altered consciousness Use of accessory neck muscles Cyanosis

Acute management Nebulised bronchodilators - salbutamol + atrovent IV MgSO4 Aminophylline infusion IV salbutamol Oral steroids - prednisolone 1-2 mg/kg daily for 3-5 days

chronic asthma (<5 years)

chronic asthma (5-12 years)

BTS / SIGN Update 2016

confirming the diagnosis

Thank You