Answers
Samar Razaq in Difficult Cases in Primary Care, 2021
This child represents step one in the management guidelines. He is currently not taking any medication and he appears to wheeze in relation to a viral infection. A lot of the time, treatment is not necessary in these so-called ‘happy wheezers’. In such cases the wheeze causes no distress and usually settles on its own accord as the infection runs its course. However, it may be unsettling for the parents. A prompt review usually settles their nerves. If there is suggestion of the wheeze affecting the child’s breathing or causing night-time cough then a short-acting β2-agonist is a reasonable first option. Its use as a reliever for occasional relief should be stressed and if it is being used more than twice a day then a step up to inhaled corticosteroids as preventer therapy should be considered. If inhaled corticosteroids are used and symptom control is achieved then the child should be reviewed, at some stage, to see if stepping down of therapy is appropriate (halving the dose of inhaled corticosteroid is one possibility).
Disorders of the respiratory system
Judy Bothamley, Maureen Boyle in Medical Conditions Affecting Pregnancy and Childbirth, 2020
Assessment will include observing respiratory rate, depth and pattern and include noting the presence of cough, wheeze or production of sputum. The respiratory rate at rest is 12–15 breaths per minute, and breathing should seem relaxed. An increased respiratory rate and a sense of breathlessness can be signs of critical ill health, and the midwife will need to assess this and be careful not to simply ‘explain away’ these features as normal. Women whose respiratory rate has increased at rest will begin to talk in short sentences, pausing to take a breath. When breathing becomes difficult, such as during an asthmatic event, inspiratory accessory muscles in the neck and abdomen may be used, raising the sternum and ribs. Wheezing characteristically occurs in asthma as air is forced through the narrowed bronchial airways10. The CMACE report11 recommended that pulmonary oedema be considered as a possible cause of a ‘wheeze’ in a pregnant woman, especially in those not known to have asthma. Noisy breathing can be caused by secretions. This occurs in chest infection or more seriously in pulmonary oedema. See Box 5.3 for red flag features that would raise concern about breathlessness in pregnancy.
Answers
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
Asthma commonly presents in childhood and is characterised by reversible airway obstruction, hyperresponsiveness of the airways to numerous allergens and inflammation of the bronchi. Symptoms tend to be wheeze, dry cough, shortness of breath and chest tightness. Childhood asthma is commonly associated with other atopic conditions, such as hay fever and eczema, and most cases resolve by adulthood. Common triggers include viral infections, exercise, cold air, the house dust mite and pollen. NSAIDs also trigger asthma in 5 %—10% of patients with asthma, so it is important to use these with caution in patients who have not received them before. Treatment is initially with inhaled salbutamol as required, and the British Thoracic Society have step-wise management guidelines for further treatment if this is not sufficient, and information on when referral to secondary care is advised.
Factors associated with medication adherence among adults with asthma
Published in Journal of Asthma, 2023
Kudret C. Özdemir, Ramune Jacobsen, Morten Dahl, Eskild Landt
Asthma was defined as affirmative answers to both of the following two questions “Has a doctor ever told you that you have asthma” and “Do you still have asthma?” (Figure 1). Asthma medication adherence was defined as an affirmative response to the question “Do you, daily or almost daily, take medication for asthma (including spray/powder)?”. Wheezing in this study was defined as confirmation of whistling or wheezing while breathing, coughing with mucus was coughing up mucus in the morning or during the daytime, and shortness of breath was often being troubled by shortness of breath. Participants also reported on asthma attacks during the past year, that merited use of reliever medications, hay-fever symptoms, use of allergy medication, acute fever, bronchitis or cystisis in the past month, pneumonia that resulted in medical visits during the last 10 years, age at asthma diagnosis, smoking status, physical activity, education, household income, and marital status. Lung function was measured using a hand-held spirometer (MicroLoop, Micro Medical Ltd, Kent, UK) as described (21). Body Mass Index (BMI) was measured weight divided by measured height squared (kg/m2).
Does the timing of antibiotic exposure in pregnancy impact the risk of development of pediatric asthma?: A systematic review and meta-analysis
Published in Journal of Asthma, 2023
Liping Wang, Xiaomei Hu, Caixia Xiang
In our meta-analysis of 11 studies including around 2 million participants, we noted that prescription of antibiotics in any trimester was linked with a small but significant 11–14% increased risk of asthma in the offspring. Importantly, the effect size was more or less similar across the three trimesters indicating that clinicians should be cautious of prescribing antibiotics to pregnant females at any time point and no period is perfectly “safe”. Our results concur with the previous meta-analysis of Bai et al. (16) which reported similar results. However, in our study, we excluded studies on wheezing (which were included in the previous review) and incorporated several recently published data to significantly increase the power of the analysis and present the most up-to-date evidence. The strength of our results is further enhanced by the stability of the results on sensitivity analysis. No study was found to have an undue effect on the results of any trimester-specific association.
Carbon footprint and associated costs of asthma exacerbation care among UK adults
Published in Journal of Medical Economics, 2022
Kalé Kponee-Shovein, Jessica Marvel, Ryotaro Ishikawa, Abhay Choubey, Harneet Kaur, Praveen Thokala, Khadidja Ngom, Iman Fakih, Todd Schatzki, James Signorovitch
Asthma is a chronic respiratory disease of the airways and lungs that places substantial burdens on individual patients and on healthcare systems1. In the UK, for example, the prevalence of asthma is among the highest in Europe, affecting 15.6% of the population, and is associated with approximately one billion pounds of National Health Service (NHS) spending a year2. Symptoms include wheezing, chest tightness, and shortness of breath, and may vary in intensity over time1. In particular, patients may experience episodic acute exacerbations of asthma symptoms that require intensification of usual treatment1. Asthma exacerbations are associated with worsening of quality-of-life for patients3,4, are a primary driver of economic burden for health systems and society5–7, and, in the most severe cases, can be life-threatening1.
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