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Pediatrics > Bronchiolitis and Asthma > Flashcards

Bronchiolitis and Asthma Flashcards

1
Q

Bronchiolitis definition

A
  • lower respiratory tract infection that affects babies and youhng children
  • children usually younger than 2, peak with 3-6 months
  • causes inflammation and congestion in the samll airways of lung
  • almost always caused by virus
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2
Q

Effects of bronchiolar injury

A
  • increased mucus secretion
  • bronchial obstruction and constriction
  • alveolar cell death, mucus debris, viral invasion
  • air trapping
  • atelectasis
  • reduced ventilation that leads to ventilation-perfusion mismatch
  • labored breathing
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3
Q

Symptoms of brichiolitis

A
  • early: runny nose and cough
  • fever
  • dry and persistent cough
  • difficulty breathing
  • rapid or noisy breathing (wheezing)
  • apnea
  • retractions
  • fine rales: diffuse, fine wheezing
  • hypoxia
  • otitis media

severe cases: respiratory destress with tachypnea, nasal flaring, retractions, irritability, cyanosis

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4
Q

Diagnostic tests in bonchiolitis

A
  • usually not necessary when clinical presentation is obvious
  • typically done to exclude other diagnoses
  • rapid viral antigen test of nasopharyngeal secretions for RSV
  • blood gas analysis
  • WBC with differential
  • CRP
  • Pulse oxymetry
  • blood cultures
  • Urine analysis, specific gravity and culture
  • CSF analysis and culture
  • serum chemistries
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5
Q

Supportive care in bronchiolitis

A
  • humidified oxygen
  • maintentance of hydration
  • mechnical ventilation
  • nasal and oral suctioning
  • apnea and cardiorespiratory monitoring
  • temperature regulation in small infants
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6
Q

Do not use any of the following to treat bronchiolitis

A
  • antibiotics
  • hypertonic saline
  • adrenaline (nebulized)
  • salbutamol
  • montelukast
  • ipratropium bromide
  • systmic or inhaled CCS
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7
Q

When to keep bronchiolitis patients in hospital

A
  • chronic lung disease
  • hemodynamically significant congenital heart disease
  • age in young infants (under 3 months)
  • premature birth, particulary under 32 weeks
  • neuromuscular disorders
  • immunodeficiency
  • apnea
  • persistent oxygen saturation of less than 92% when breathing air
  • inadequate oral fluid intake
  • persisting severe respiratory distress
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8
Q

When to consider a pneumonia

A
  • high fever (over 39°)

- persistently focal crackles

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9
Q

Asthma symtpoms

A
  • wheezing
  • shortness of breath
  • chest tightness
  • cough
  • variable expiratory airflow
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10
Q

Three mechanisms in asthma

A
  1. bronchocontriction
  2. increased mucus
  3. airways wall thickening
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11
Q

Symptoms in asthma can be triggered by:

A
  • viral infection
  • allergens
  • tobacco smoke
  • exercise
  • stress
  • irritants such as fumes, strong smells
  • changes in weather
  • laughter
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12
Q

Diagnosis of asthma

A
  • based on history of characteristic symtpom patterns

- evidence of limited airflow, from bronchiodilator reversibility teting or other tests

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13
Q

Increased porbability that symptoms are due to asthma, if:

A
  • more than one type of symptom
  • symptoms worse at night or in the early morning
  • symptoms vary over time and in intensity
  • symptoms are triggered by something
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14
Q

Decreased probability that symptoms are due to asthma, if:

A
  • isolated cough with no other respiratory symptoms
  • chronic production of sputum –> think of CF or something else
  • shortness of breath associated with dizziness or peripheral tingling
  • chest pain
  • exercise-induced dyspnea with noisy inspiration
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15
Q

Airflow limitation in asthma

A
  • FEV1/FVC is reduced
  • normal: >0.75-0.8 in adults and >0.9 in children
  • exessive bronchodilator reversibility (children: increase > 12% predicted)
  • significant increased in FEV1 or PEF after 4 weeks of controller treatment
  • excessive diurnal variability from 1-2 weeks twice-daily PEF monitoring
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16
Q

Physical examinations in asthma

A
  • often normal
  • most frequent finding: wheezing on auscultation, especially on forced expiration
  • wheezing may be absent during severe asthma exacerbations (“silent chest”)
17
Q

Different symtpom patterns in asthma in children under 5 years

A

PATTERN 1

  • symptoms for under 10 days in URTI
  • 2-3 episodes per year
  • no symptoms between episodes

PATTERN 2

  • symptoms for over 10 days during URTI
  • over 3 episodes per year, or severe episodes and night worsening

PATTERN 3

  • symptoms for over 10 days during URTI
  • over 3 episodes per year, or severe episodes and nigth worsening
  • between episodes child has cough, wheeze or heavy breathing during play or when laughing
  • atopy, or family histpry of asthma
18
Q

Asthma management is aimes at reducing airways inflammation by:

A
  • minimizing proinflammatory environmental exposures
  • using daily controller anti-inflammatory medications
  • controlling comorbid conditions that can worsen asthma (like GERD, all. rhinitis)
19
Q

Treatment of asthma in children between 6-11

A

RELIEVER: as-needed short-acting ß-agonist (SABA)

steps for controlling
STEP 1
- only reliever

STEP 2
- Daily low dose inhaled corticosteroids (ICS)

STEP 3
- low dose ICS-LABA or medium dose ICS

STEP 4
- Medium dose ICS-LABA

STEP 5
- refer to phenotypic assessment and add-on therpay (like anti-IgE)

20
Q

Treatment of asthma in children over 12

A

RELIEVER STEP 1/2: as-needed low dose ICS-formoterol
RELIEVER STEP 3/4/5: as-needed low-dose ICS-formoterol for patients prescribed maintencance and reliever therapy

steps for controlling
STEP 1 (symtpoms less than twice a month)
- as-needed low dose ICS-formoterol

STEP 2: (symtpoms twice a month or more)
- daily low-dose ICS, or as-needed low dose ICS-formoterol

STEP 3 (symtpoms most days, or waking with asthma once a week or more)
- low dose ICS-LABA
STEP 4 (symtpoms most days, or waking with astma once a week or more, and low lung function)
- medium dose ICS-LABA

STEP 5

  • high dose ICS-LABA
  • refer to phenotypic assessment and add-on therapy
21
Q

Possible ICS

A
  • beclometasone dipropionate
  • budesonide
  • ciclesonide
  • fluticasone
  • mometasone
22
Q

Treatment of asthma in children 5 years or younger

A

RELIEVER: as -needed short-acting ß-agonist

controller steps
STEP 1 (infrequent viral wheezing and no or few interval symtpoms)
- only reliever

STEP 2 (symtpom pattern not consistent with asthma but wheezing episudes occur frequently, symtpom pattern consistnt with asthma and symtpoms not well-controlled or over 3 exacerbations per year)
- daily low-dose ICS
STEP 3 (asthma diagnosis and asthma not well-controlled on low dose ICS)
- double low dose ICS
STEP 4 (astma no well-controlled on double ICS)
- continue controller and refer for specialist assessment
23
Q

Mild asthma exacerbation in children under 5

A
  • no altered consciousness
  • O2 over 95%
  • speech in sentences
  • pulse over 100/min
  • absent central cyanosis
  • variable wheeze intensity
24
Q

Severe asthma exacerbation in children under 5

A
  • agitated, confused, drowsy
  • O2 under 92%
  • speech in words
  • pulse over 200/min (0-3) or over 180/min (4-5)
  • central cyanosis likely
  • chest may be quiet
25
Q

Transfer to hospital in asthma exacerbations in children under 5

A
  • child is unable to speak or drink
  • cyanosis
  • subcostal retraction
  • oxygen saturatin under 92
  • silent chest
  • lack of response to intial bronchodilator treatment
  • persisting tachypnea
26
Q

Initial management of asthma exacerbations in children under 5

A
  • supplemental oxygen
  • inhaled SABA
  • Systemic CCS

additional options in the first hour of treatment

  • ipratropium bromide
  • magnesium sulfate

Pediatrics (11 decks)

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