1. asthma in the child
Dr A Rahman
GPST3

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

3. 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

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

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

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

7. 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

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

9. chronic asthma (<5 years)

10. chronic asthma (5-12 years)

11. BTS / SIGN Update 2016

12. confirming the diagnosis

13. Thank You