(4.4) Cardiac Pulmonary and Renal Pediatric Pearls 1 (PART 2) (Asthma) [CIS-Newman]

Question 1

What are the essentials of diagnosis of asthma?

Answer 1

• Episodic airflow obstruction
• Reversibility of airflow obstruction
• Sx worse at night or early morning
• Prolonged expirations
• Limitation of airflow

Question 2

Clinical sx of asthma?

Answer 2

• Cough
• Wheezing
• Chest tightness
• Prolonged exhalation
• SOA

Question 3

Exposure to _______ can trigger asthma

Answer 3

Exposure to allergens can trigger asthma

Question 4

Describe the differences in a normal airway vs airway in asthma:

Answer 4

Airway in asthma:

• Lots of mucus production
• immune cell infiltrates
• increased gland production

Question 5

What are the two hallmark features of prolonged status asthmaticus?

Answer 5

Curschmann spirals

Charcot-Leyden crystals

Question 6

What occurs in chronic asthma?

Answer 6

Airway remodeling

• THICKENING of the airway wall
• Sub-basement membrane FIBROSIS
• Increased VASCULARITY
• HYPERTROPHY/HYPERPLASIA of the bronchial wall muscle

Question 7

What is the strongest predisposing factor to asthma?

Answer 7

Atopy

Question 8

What is the significant difference b/w COPD and Bronchial asthma in terms of FEV1 and FEV1/FVC ratio returning to normal with drug therapy?

Answer 8

COPD = WILL NOT IMPROVE

Bronchial asthma = WILL PROBABLY IMPROVE

**Likely a test question

Question 9

What does this spirometry likely indicate?

Answer 9

COPD

Note the spike with the long expiratory phase

Question 10

What does this spirometry likely indicate?

Answer 10

Vocal cord dysfunction

Question 11

What does this spirometry likely indicate?

Answer 11

Asthma

Question 12

What are the major SABAs?

Answer 12

Albuterol (MAIN ONE)

Levalbuterol (isomer of albuterol)

Question 13

Most common leukotriene modifier?

Answer 13

Montelukast

Question 14

What are the symptoms of respiratory arrest imminent?

Answer 14

While at rest, bute

Silent

Drowsy or confused

Question 15

What are the signs of respiratory arrest imminent?

Answer 15

RR >30/min

Unable to recline

Paradoxical thoracoabdominal movement

Abesnt wheeze

Bradycardia

Question 16

What are the functional assessment numbers of respiratory arrest imminent?

Answer 16

FEV1 <25%

PaO2 <60; possible cyanosis

PCO2 >42

SAO2 <90%

Question 17

Let’s say you have a child that is in the “intermittent” category of asthma severity. HOWEVER…within their “risk”category, they have at least 2 events a year where they have to go to the hospital. What does this do to change their “intermittent” classification?

Answer 17

They enter the “persistent” category.

Even if the pt. has all the impairment indications for intermittent, if the RISK category if affected, you have to increase their severity.

This child will now be in the PERSISTENT categories

Question 18

Your pediatric patient has been within STEP 1 of control for their intermittent asthma. However…their SABA is no longer able to control their asthma. What is the next step in controlling their asthma?

Answer 18

ADD a low dose ICS

Question 19

Always use a MDI with…

Answer 19

A spacer!!!

Question 20

What is a asthma action plan?

Answer 20

Written instructions on how to manage asthma symptoms for designated “zones” (green, yellow, red)