Asthma Flashcards
What are the symptoms of asthma?
- Shortness of Breath
- Chest tightness
- Cough
- Wheezing
- Chest pain
- Rhinorrhea
What are common exacerbating factors for asthma?
- Viral infection
- Allergens (dust, pollen..)
- Irritants (smoke, fumes)
- Exercise
- Emotions
- Change in humidity
How come wheezing might not be present in a child presenting with asthma?
- Airway obstruction may result in poor air movement
On exam what findings might be present in a patient presenting with asthma exacerbation?
- Tachypnea
- Tachycardia
- Cough
- Wheeze
- Prolonged expiration
- Cyanosis
- Retractions and accessory muscle use
- Tripod position
- Pulsus paradoxus
- May see other evidence of atopic disease (eczema, allergic rhinitis)
What is pulsus paradoxus?
- Decrease in blood pressure of >15mm Hg with inspiration
What are the 3 criteria needed for a diagnosis of asthma?
1) Episodic symptoms of airflow obstruction
2) Airflow obstruction is at least partially reversible
3) Alternative diagnosis are excluded
What is pulsus paradoxus associated with? List 5 things
1) Obstructive lung disease (Asthma and COPD)
2) PE
3) Tension pneumo
4) Cardiac tamponade
5) Pericarditis
6) Croup
7) Chronic sleep apnea
When should a chest radiograph be performed in a child presenting with asthma?
- First episode of asthma (or with recurrent episodes of undiagnosed cough) to rule out anatomic abnormality
- If child presents with fever (rule our pneumonia)
- Otherwise a child with known asthma who is afebrile does not require CXR
What is the preferred long term control therapy medication for those with asthma?
- Inhaled Corticosteroids
Why do you counsel patients to rinse their mouths after using inhaled steroids?
- Decreases G.I. absorption
- Reduces risk of:
- Dysphonia
- Oral candidiasis
What are the effects of inhaled steroids on growth?
- May decrease growth velocity (approx 1cm in first year)
- Generally not progressive and may be reversible
- Note that poorly controlled asthma will also reduce growth velocity
What are leukotriene modifiers? How are they given?
- Leukotrienes are potent mediators of inflammation and smooth muscle bronchoconstriction
- All oral medications
- Most popular (montelukast or singulaire) is a leukotriene receptor antagonist
When should a long acting beta-2 agonist be used?
- If inhaled steroid treatment alone is not sufficient, adding a long acting bronchodilator to inhaled steroid is more effective.
- Note combination inhalers of ICS and LABA improve compliance
Fomoterol and salmeterol are in which class of medication?
- Long acting beta-2 agonist (LABA)
- Bronchdilator
What is theophylline?
- Bronchodilator, not commonly used anymore
What is typically the role of a short acting beta-2 agonist?
- Acute symptom relief
- Prophylaxis before exposure or exercise
- Note overuse of this suggests poor asthma control (over 8 puffs per day or using over 1 puffer per month)
How do anticholinergic agents work?
- bind to acetylcholine at muscarinic receptors in the bronchial smooth muscle
- decreases mucous hypersecretion
- counteracts cough receptor irritability
What is the role for long term use of anticholinergic medications in treating asthma?
- Long term use is currently not supported by the literature
What is the role of oral corticosteroids in the treatment of asthma?
- Treatment of acute exacerbations
What dose of oral dexamethosone would you use in an acute asthma exacerbation? For how long would you use it?
- 0.6mg/kg
- Max dose is 16mg/dose
- Single dose or may be repeated in 24 hours once
- Not recommended any longer due to risk of metabolic effects
What dose of oral prednisone or prednisolone would you use for acute asthma exacerbation? For how long?
- 0.2mg/kg/day on day one, then 0.1-0.2mg/kg/days for the next 2-4 days (3-5 days total)
What are the Rules of Two? What do they tell you?
- The rules of two is a tool to determine if a childs asthma is persistent or intermittent
- It is persistent if when there is either:
- Daytime symptoms occurring 2 or more times per week
- Nighttime awakening two or more times per month
- If persistent requires a daily anti-inflammatory medication (ICS)
What is status asthmaticus?
- An acute exacerbation of asthma that does not respond adequately to therapeutic measures and may require hospitalization.
What is your initial management for a patient with asthma exacerbation?
- ABC’s
- Vitals/Monitor (O2 sats important)
- Supplemental oxygen
- Short acting bronchodilators (salbutamol +/- ipratropium)
- Early oral corticosteroids
