Asthma Flashcards
major criteria assoc with the development of persistent asthma:
parent with asthma or Hx of atopic dermatitis
Atopic disease focuses on IgE-mediated hypersensitivity (eczema or atopic dermatitis, food allergy, asthma and allergic rhinitis)
*** asthma and allergic rhinitis are likely to persist throughout life
minor criteria assoc with the development of persistent asthma:
Maternal Hx of atopic disease or allergic rhinitis or >4% eosinophilia, or wheezing not assoc with URI
describe the pathophysiology of asthma
airway hypersensitivity, usually with a significant IgE mediated component, which results in inflamation including mucus secretion and edema and smooth muscle airway constriction
over time the smooth muscle layer of airway becomes hypertrophied with collagen deposition in the basement layer→ permanent lung remodeling
common symptoms of asthma:
nocturnal cough→ during well periods, esp a dry cough between 2-4am (when epi naturally decreases→ epi no longer dilating bronchioles, bronchoconstriction causes cough
Exercise intolerance→ coughing when playing or need to sit down to catch breath after running►due to bronchocxn
Hx of RSV, wheezing with URIs→ RSV bronchiolitis in infancy is risk factor for later development of asthma as is a Hx of wheezing with URIs. Likely to outgrow by age 6 as airways grow larger
Previous use/response to albuterol→ supports the reversibility of patient’s airway constriction
DDx for wheezing and coughing in pediatric patient:
bronchiolitis, foreign body aspiration, congestive heart failure (congenital heart defects which result in excessive fuild backup in into the lungs→ will be tachypnic, coughing and wheezing), antomic malformations, TB, cystic fibrosis
describe the use of spirometry in the Dx of asthma:
asthma= air trapping disease→ test the ability to force air volume from the lungs (gold standard) for diagnosis and to follow asthma progression or improvement with Tx
spirometry= Pt’s air expiration in 1 sec, followed by a more sloping curve of slow expiration
*instructions are too complicated for kids under 5yo
assign an appropriate asthma classification for:
intermittent
mild presistent
moderate persistent
severe persistent
intermittent: using albuterol <2x/week
mild presistent: use of albuterol or rescue inhaler 2+times/wk
moderate persistent: noctural cough/wheezing or inhaler use 2x/month
severe persistent: symptoms present ALL the time
**pre-exercise Tx does not count in #s for albuterol use, but a need for albuterol during or after needs to be taken into account
characterize the 3 levels of asthma control
design a management plan for a patient with a Hx suspicious for asthma:
Take a good Hx and FHx for atopic disease→ ask about eczema or atopic dermatitis, food allergy, asthma, and allergic rhinitis
PE: ausculation of lungs→ hearing wheezing requires questions about Hx of URI, nighttime coughing, exercise -induced symptoms
Has patient ever used an inhaler-if so-did symptoms improve? Gold standard is to do spirometry if child is over 5yr.
design a managment plan for a 0-4yo patient with intermittent and persistent asthma:
Intermittent→short acting beta agonist (with spacer), as needed for symptoms q4-6hrs. Should be using less than 2x/week
*educate that wheezing may improve around age6 when airway grows bigger
Persistent→ Low dose Flovent (off-label) until age 4, then LABA salmetrol or Advair with fluticasone
Both: asthma control test/ control assessment
asthma education (disease process, instruct parents on proper use of equipment, allergen control, tobacco smoke exposure)
Follow-up according to level of control
design a managment plan for a 5-11 yo patient with persistent asthma:
Classify using rules of two
asthma control test/control assessment
use chart to determine which management step is most appropriate
asthma education
peak flow meter
asthma action plan
follow up according to level of control
management of acute asthma exacerbations
2-4 puffs SABA via MDI/ spacer or neb
repeat x3 q20min
if improved→ Rx oral corticosteroids and send home with instructions, F/U 1-3 days
management of acute asthma exacerbations→ what to do if significant respiratory distress develops
requires supplemental 02
rebound wheezing
SOB after SABA
poor response to SABA
to ED for continuous SABA, observation, possible admission
