Asthma Flashcards
Pathphys of cough
cough is a protective action –> initiated both voluntary and by cough receptors in respiratory tract
*receptors send signals to cough center (medulla) –> signal to vagus, phrenic, and spinal motor nerves –> cough
Assessing kids in respiratory distress
Speaking in full sentences?
SOB when speaking?
Causes of cough in kids
Infection Inflammation Irritation Anatomic Psychogenic
Acute Cough
more likely infectious or clear precipitating event
Chronic cough
more likely to mean it is not a life-threatening because symptoms have been tolerated for so long
Descriptors of a cough
Dry - irritant or asthma Wet/productive - lower respiratory infection Barky - croup Paroxysmal - pertussis, foreign body Worse at night - sinusitis or asthma Gagging - GERD
Wheeze
high-pitched whistling sound made when airway is narrowed by inflammation
Shortness of breath
difficulty breathing or sensing you are short of breath
ROS in kid with cough
Fever? - infection Change in voice? - chronic rhinitis or GERD Choking event? - foreign body or GERD Chest pain? - GERD or asthma Head ache? - sinusitis Sore throat? - post-nasal drip or URI
Pulmonary TB in kids
systemic symptoms are uncommon –> most symptoms are from bronchial compression (wheeze, cough)
CXR - hilar adenopathy with some mild hyperinflation
DDx for cough in kid
Asthma - common, cough worse at night (shiners)
Allergies - also common, post-nasal drip
Sinusitis
Bronchitis - clinical diagnosis from chronic cough and congestion from URI
GERD - worse at night
Atypical PNA - viral causes or atypical (influenza, adenovirus, mycoplasma)
Sign and Symptoms of Bacterial Sinusitis
TONS of similarity between viral URI and sinusitis
- Sinusitis = persistence of symptoms
- purulent nasal discharge with fever
Bacterial Sinusitis
Same bugs as AOM
Factors - allergies, URI, CF, thick mucus, trauma, polyps
Diagnosis - persistent symptoms, worsening cough, severe onset
Tx - amoxicillin
Tracheal deviation
suggest a mass or PTX
Retractions
seen in obstructive airway disease, asthma, foreign body,
Accessory muscle use
sign of significant respiratory distress
Hyperinflated thorax
increased AP chest diameter –> air-trapping from obstructive lung disease
Increased I:E
increased expiration time –> obstructive disease
Percussion
Hyperresonance - air-trapping (mucus plug, obstructive)
Dullnes - consolidation (PNA)
Egophony
EE and AA –> consolidation
Wheezing
sound of airflow through narrowed airways –> sign of asthma or reactive airway disease
- musical sounds (usually during expiration)
Rhonchi
continuous low-pitched sounds during inspiration/expiration
- due to mucus/secretions in airway
Crackles
heard on inspiration due to fluid in alveoli –> PNA
Stridor
high-pitched inspiratory noise from airway obstruction of extrathoracic airway (trachea or larynx)
Atopy
predisposition to IgE associated allergic reactions –> allergic rhinitis, asthma and eczema
- house dust mites, animal dander, ragweed, pollen
Management of Allergies
reduce exposure
Meds: antihistamines, anti-leukotrienes, nasal sprays
Diagnosing asthma
Nature of symptoms
Precipitating factors
Family History
Spirometry is best
Metered Dose Inhalers
good for delivering meds –> use spacer
Adthma epidemiology
1 in 13 kids effected by asthma
Pathophsy of asthma
biphasic inflammatory response
- early reaction with mast cells and eosinophils –> PGs and LTs –> mucus and bronchoconstriction
- later –> neutrophils, eosinophils, lymphocytes –> epithelial destruction and remodeling
Long-term management of asthma
1 - Classify severity based on PFTs
2 - Gain control quickly
3 - minimize use of beta-2 agonists
4 - multfactorial management
Inhaled steroids for asthma
use for patients with persistent symptoms
- inhaled = quicker onset and lower dose
- take time before fully effective
Types of asthma therapy
Rescue medication - SABA (beta-2 agonist like albuterol)
Maintenance medication - LABA or inhaled steroid
Peak flow meter
measures peak expiratory flow rate (PEFR)
- keeping diary helps determine effectiveness of therapy
- helps manage exacerbation in ED
Spirometry
measures active lung volume
FEV1/FVC
Obstructive disease spirometry
reduced airflow and airway trapping
- low FEV1 and low ratio of FEV1/FVC
Restrictive disease spirometry
low FEV1 but proportionate low FVC –> no change in ratio
Asthma Action Plan
mainstay of asthma management
- easy to follow instructions based on symptoms and peak flow readings
Follow up for asthma
every 2-6 weeks until well controlled –> then every 6 months to a year
Checklist for families about asthma
- know how to use peak flow meter and inhalers
- asthma diary
- understand asthma action plan
- know triggers
- ongoing assessment
