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Paeds Vivasrespiratory-sleep-and-airway

Paeds Vivas · respiratory-sleep-and-airway

Asthma diagnosis and long-term control — branching viva

Branching viva from the definition and objective confirmation of childhood asthma through the phenotype and control classification, the inflammatory pathophysiology, the stepwise controller ladder and the anti-inflammatory reliever evidence, to the poorly controlled adolescent and the diagnostic mimics.

branching clinical structured oral4 min readVerification in progress

Target exams

RACP DWEMRCPCH ClinicalRCPCH Progress+
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Study tools

Target exams

RACP DWEMRCPCH ClinicalRCPCH Progress+
Prompt
You are the paediatric registrar in a respiratory clinic. The consultant asks you to talk through four children: a 7-year-old with recurrent cough and wheeze needing a diagnosis, a preschooler with recurrent viral wheeze, an adolescent whose asthma looks uncontrolled, and a child whose 'asthma' has never responded to treatment.

Station opening

Examiner: "Define asthma in a child and explain why it is a clinical diagnosis rather than one made on a single test." [5]

Strong candidate (must-hit)

  • Defines asthma as a chronic inflammatory disorder of the airways producing variable, reversible airflow obstruction, presenting as recurrent, trigger-provoked, nocturnal wheeze, cough, breathlessness and chest tightness that respond to a bronchodilator; explains that there is no single confirmatory test, so the diagnosis rests on the characteristic variable pattern, the objective demonstration of variable airflow limitation, and the exclusion of the mimics; and names variability and reversibility as the two defining features. [5] [10]

Weak candidate

  • "Asthma is when a child wheezes and we give them a blue inhaler." [5]
Paediatrics Fellowship Pro

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You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship library.

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References6ShowHide
  1. [1]Martinez FD; Wright AL; Taussig LM; Holberg CJ; Halonen M; Morgan WJ Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med, 1995.PMID 7800004
  2. [2]Castro-Rodríguez JA; Holberg CJ; Wright AL; Martinez FD A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med, 2000.PMID 11029352
  3. [5]Bacharier LB; Boner A; Carlsen KH; Eigenmann PA; Frischer T; Götz M; et al Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. Allergy, 2008.PMID 18053013
  4. [8]O'Byrne PM; FitzGerald JM; Bateman ED; Barnes PJ; Zhong N; Keen C; et al Inhaled Combined Budesonide-Formoterol as Needed in Mild Asthma. N Engl J Med, 2018.PMID 29768149
  5. [10]Levy ML; Bacharier LB; Bateman E; Boulet LP; Brightling C; Buhl R; et al Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. NPJ Prim Care Respir Med, 2023.PMID 36754956
  6. [11]Chauhan BF; Ducharme FM Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children. Cochrane Database Syst Rev, 2012.PMID 22592685
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