Asthma and Wheezy Child Flashcards
Define asthma
Chronic inflammatory pulmonary disorder which is a reversible obstruction
Risks for asthma
Maternal smoking Atopy or family history of asthma/atopy Males more often than females < 14 yrs (opposite >14 - taller) Pollution (NO2, ozone) Obesity Viral infections (?)
Common triggers of Asthma
Allergens Air pollution Cigarettes Cold air Dust Drugs Exercise Laughing, crying Resp infections
Pathophysiology of Asthma
Mediated by mast cells early on, then Eosinophils and lymphocytes in chronic.
Poorly controlled asthma can lead to COPD-like symptoms
Symptoms of Asthma
Classic pattern of wheeze, cough and dyspnea, especially in response to triggers like exercise, illness, or if intermittent or at night
How to assess good asthma control
Be specific - people get used to symptoms
Day or night symptoms should be rare
Exercise tolerance should be fine if controlled.
Any missed days of work/school?
Shouldn’t need SAßA often.
Key tests and findings of Asthma
PFT - should reverse and be normal after bronchodilator
Methacholine test - see premature closure of airways (less common)
Tx and management of Asthma
- confirm Dx. ie, reversible
- look at triggers, make a plan.
- get fast-acting bronchodilator when needed (ideally never using it!). Aka rescue puffer.
- probably need control medication (ICS)
- leukotriene R antagonist (LTRA) is 2nd line here - in mod/severe: LABA, LTRA
- Prednisone is last ditch effort. Try to avoid.
Facts about corticosteroids. Why important for Asthma?
Decrease inflammation cells and mediators, mucous; activates ß2 receptors to open airway; limit progression of disease. Don’t stunt growth, good for mother and fetus in pregnancy.
Explain the early and late phase responses
The longer it goes on, you get desensitized to the SAßA bronchodilator. Late phase is more day-to-day. Can lead to fatal asthma
Wheezing defined
Noise Expiratory Prolonged expiration Airway narrowing (from any cause: swelling etc.) Intra thoracic
Stridor defined
Inspiratory noise Airway narrowing (upper) Extra thoracic airway Harsh High pitched Loud inspiratory sound Rapid airflow through a narrowed passage
Compare stridor and asthma on PFT
Stridor is flattened inhalation. Asthma more obstructive
What do acute and chronic wheeze look like?
Acute: S.O.B., Cough, Wheeze, Anxiety
Chronic: Wheeze, Night Cough, Prolonged Cough/wheeze with URTI, Exercise Limitation (lifestyle)
Generate a differential diagnosis for an infant or toddler with wheeze
Congenital anomaly (eg fistula) Infection, esp RSV Aspiration (GERD) Cystic Fibrosis Environment/Smoke Variant of normal
Investigations for infants with wheeze
Physical exam -Dysmorphic features -Growth -Stridor or wheeze? CXR Sweat test (CF) Barium swallow (look at esophagus, trachea indirectly) Bronchoscopy pH probe
Dx, symptoms, and Tx for Respiratory Syncitial Virus bronchiolitis
Peak age 2-6 months
Increased risk: smoke exposure/premature birth/crowded environment/CHD/BPD/reactive airways/CF
Dx usually clinical, maybe find Ag
No Tx, just supportive.
Ddx for Toddlers with wheeze
Congenital Malformation Cystic Fibrosis Infections Aspiration Reflux Foreign Body - only new one Smoke Normal Same investigations as with infants, just trickier
Discuss some of the common conditions that can lead to wheezing in a school age child
Congenital (should have caught by now) Cystic Fibrosis Reflux Pertussis - new Atypical pneumonia - new Foreign body Sinusitis - less common
Discuss some of the common conditions that can lead to wheezing in an adolescent
Smoking Sinusitis Out-of-shape/obesity Psychogenic or "habitual" cough Vocal cord dysfunction (weird stress phenomenon causing stridor) Foreign body
