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Pediatrics > Asthma > Flashcards

Asthma Flashcards

1
Q

What is the most common chronic disorder in children and adolescents?

A

Asthma

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2
Q

Define Asthma

A

Recurrent symptoms of airway obstruction that respond to a bronchodilator and often have specific triggers

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3
Q

Second Way to Define Asthma

A

Chronic inflammatory disease of the airways with airway obstruction that’s reversible, airway inflammation, increased airway hyper responsiveness, or airway remodeling

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4
Q

Development of Asthma

A

Genetics
Environment
Airway Inflammation
Bronchoconstriction

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5
Q

Types of Allergens

A 
Dust mites
Pet dander
Pollen
Rodents
Mold
Natural oils
Organics
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6
Q

Types of Irritants

A 
Smoke
Strong fumes
Pollution
Ozone
Chemicals
Petroleum
VOCs
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7
Q

Other Triggers of Asthma

A 
URI
Tobacco
Exercise
Cold air
GERD
Chronic sinus diseaes
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8
Q

Presentation of Asthma and NSAIDs

A 
Chronic rhinitis
Nasal polyps
Asthma
Malaise
Rhinorrhea
Bronchospasm
Productive cough
Angioedema
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9
Q

When to Suspect Asthma

A

Persistent cough
Recurrent pneumonia
Responds to albuterol

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10
Q

History is Most Important

A 
Recurrent cough
Wheeze
Shortness of breath
Improvement of bronchodilator
Clear triggers
PMH: allergic child
Family Hx: maternal
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11
Q

Physical Exam Findings in Asthma

A 
Tripod breathing
Tachypnea
Hypoxemia
Dyspnea
Retractions
Poor aerations
Wheezing
Prolonged I:E ration
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12
Q

Differential Diagnosis of Asthma

A 
Allergic rhinitis
Sinusitis
FB
Vascular ring/sling
Laryngo/tracheo/ bronchomalacia
Vocal cord dysfunction
Bronchiololitis
CF
Bronchopulmonary dysplasia
Heart disease
Aspiration/GERD
Asthma
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13
Q

Goals of Treatment of a Pediatric Asthmatic

A

Sleep
Learn
Play

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14
Q

Risk of Exacerbations

A 
Severe obstructive disease
2+ ED/hosp in the last year
Patients frightened by exacerbations
Non-white
Women
No ICS
Lower SES
Depression
Stress
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15
Q

Mechanism of ICS in Asthmatics

A

Anti-inflammatory

Reverse beta2 receptor down regulation

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16
Q

Treatment Options of Moderate Persistent Asthma

A

Medium dose ICS
Low dose ICS with LABA
Low dose ICS with LTRA

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17
Q

MOA of Leukotriene Blockers

A

Inhibit inflammation through different pathway

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18
Q

What can Leukotriene Blockers Assist with?

A 
Toddlers who wheeze with viruses
Spare steroids
Pill vs. inhaler vs. nebulizer
Not as effective as ICS
May have psych SE
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19
Q

Tools for Asthma Care

A

Handouts
Peak flow meters
Spacers
Spirometry

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20
Q

Treatment of Asthma

A

Asthma Action Plan (AAP)

Symptom or peak flow

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21
Q

Management of Asthma

A

Follow up
Education
Medications
Spirometry annually

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22
Q

Step Up or Step Down Therapy

A

Step up therapy if no response in 4-6 weeks

Step down therapy if good control for 3 months

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23
Q

Instances for Referrals

A

High risk asthma
Atypical signs/symptoms
Comorbid disease
Need for additional resources: psychosocial

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24
Q

Define High Risk Asthma

A

Multiple hospitalizations or ED visits
More than 3 steroid bursts/year
Requiring high dose ICS

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25
Q

Possible Options of Comorbid Disease that Complicate Asthma

A

Allergies
Chronic sinusitis
GERD

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26
Q

Types of Medication Delivery

A 
MDI's
Spacers
DPI's: dry powder inhalers
Nebulizers
Pari nebulizers
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27
Q

MDI Delivery with Spacer

A 
Shake vigorously
Fully exhale breath/ place spacer in mouth
Press down on inhaler
Slow, deep breath
Hold breath 10 secs
Wait between 30-60 seconds btw doses
Rinse mouth
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28
Q

MDI Delivery with Mask Spacer

A 
Shake vigorously
Fully exhale
Place mask over spacer
Press down on inhaler
Keep mask in place 5-8 breaths
Wait 30-60 seconds btw doses
Rinse mouth
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29
Q

DPI Delivery

A 
Hold inhaler steadily
Actuate inhaler
Deep, fast breath
Hold breath for 10 seconds
Rinse mouth
30
Q

Define Asthma Action Plan

A

Written plan of care from health care provider, includes zones & symptoms

31
Q

What is the Asthma Action Plan for?

A

Treating Asthma Symptoms

32
Q

What does an Asthma Action Plan Include?

A

Medication information
Usual triggers
Special instructions

33
Q

Define Controlled Asthma/Green Zone

A

No symptoms
Active, eating & sleeping well
Peak flows at least 80% of best

34
Q

Goal of Green Zone

A

Participate in all activities & not be limited by asthma

35
Q

Define Yellow Zone

A 
Coughing
Wheezing
Chest tightness
SOB
Peak flows 50-80%
SABA for symptoms
36
Q

When does a child in the yellow zone contact their PCP?

A

12-24 hours

Breathing symptoms increase

37
Q

Define Red Zone

A

“Quick relief” not effective

38
Q

Symptoms of the Red Zone

A 
Bluish lips
Pale
Difficulty talking, walking, or drinking
Retractions in neck, throat, or chest
Nasal flaring
Obvious distress
Altered level of consciousness/confusion
39
Q

Acute Management in the ED

A

3 back to back nebulizer treatment with albuterol & atrovent

40
Q

Respiratory Failure Interventions

A 
Increased albuterol dosing
SubQ terbutaline
SubQ epi
IV Magnesium
Bipap
41
Q

What do you on discharge of an asthma patient?

A

Education
AAP
Controller medications
Re-label medications for home use

42
Q

Successful Management of Asthma

A

Routine monitoring of lung function
Patient education
Environmental factors
Pharm

43
Q

Airflow Limitations

A

Bronchoconstriction
Airway hyperresponsiviness
Airway edema

44
Q

Symptoms Patterns of Asthma

A

Perennial vs. seasonal
Continual vs. episodic
Duration, severity, & frequency
Diurnal variations

45
Q

Players in Asthma

A

Eosinophils
Lymphocytes
MAST cells
Leukotrienes

46
Q

What do leukotrienes do?

A

Increased vascular permeability/edema
Increased mucus production
Decreased mucociliary transport
Inflammatory cell recruitment

47
Q

Intrinsic Asthma

A

Non-immune
No personal/family hx
IgE levels normal
Stimuli with no effect in normal subjects can trigger bronchospasm

48
Q

Stimuli in Intrinsic Asthma

A 
ASA
Pulmonary infections
Cold
Psychological stress
Exercise
Inhaled irritants
GERD
Post nasal drip
49
Q

Extrinsic Asthma

A

Type-1 hypersensitivity reaction
Family hx
IgE & eosinophil elevated

50
Q

Define Exercise Induced Asthma (EIA)

A

Exercise or vigorous physical activity triggers acute bronchospasm in persons with heightened airway reactivity

51
Q

Classic Triad of Symptoms for Asthma

A

Persistent wheeze
Chronic episodic dyspnea
Chronic cough

52
Q

Associated Symptoms of Asthma

A 
Tachypnea
Tachycardia
Systolic HTN
Harsh respirations
Prolonged expiration
Wheezing
Sputum production
Chest pain or tightness
Hemoptysis
Diminished breath sounds
Pulses paradoxus
53
Q

Diagnostics of Asthma

A 
PFT's
Provocation testing with methacholine
CXR
GERD assessment
Skin tests
Eosinophils & iGE elevations
54
Q

Global Strategy for Asthma and Prevention

A 
Achieve/maintain control of symptoms
Prevent exacerbations
Maintain "normal" pulmonary function
Maintain normal activity levels
Avoid adverse effects from meds
Prevent the development of irreversible airflow limitation
Prevent mortality
55
Q

What is an asthma Action Plan for?

A

Daily management and for adjusting medications in response to increasing symptoms

56
Q

Management of Asthma

A

Management of exacerbations
Regular follow up
Classify severity before treatment

57
Q

4 Classifications of Asthma

A

Step 1: Intermittent
Step 2: Mild persistent
Step 3: moderate persistent
Step 4: severe persistent

58
Q

Intermittent Asthma

A

Daytime asthma symptoms

59
Q

Treatment of Intermittent Asthma

A

SABA for rescue PRN

60
Q

Mild Persistent

A

More than twice/week
3-4 nocturnal awakenings/month
SABA use >2 times/week
Minor interference with normal activities

61
Q

Treatment of Mild Persistent

A

SABA for rescue PRN

Low dose ICS

62
Q

Moderate Persistent

A

Daily symptoms
Nocturnal awakenings >1 times/week
Daily SABA use
Some limitation in normal activity

63
Q

Treatment of Moderate Persistent

A

SABA for rescue PRN
LABA + low-medium ICS
Consider referral to specialist

64
Q

Severe Persistent

A

Symptoms throughout the day
Nightly nocturnal awakenings
SABA several times/day
Extreme limitation in normal activity

65
Q

Treatment of Severe Persistent

A

SABA for rescue PRN
High dose ICS + LABA
Refer to specialist

66
Q

Controlling Asthma Severity

A

Minimizing exposure to contributing factors

67
Q

Define Status Asthmaticus

A

Severe bronchospasm that is unresponsive to routine therapy

68
Q

Presentation of Status Asthmaticus

A 
Difficulty talking
Using accessory muscles of inspiration
Orthopnea
Diaphoresis
Mental status changes
69
Q

Treatment of Status Asthmaticus

A

Oxygen
Oximetry
ABG’s
Peak flows with treatments

70
Q

Inadequate Response of Status Asthmaticus

A

Hospital admission

71
Q

Good Response of Status Asthmaticus

A

Inhaled B2agonist
Inhaled anticholinergic
Oral steroids x 5 days
Follow up in 5 days

Pediatrics (23 decks)

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