Childhood Asthma Flashcards by CM A

A chronic inflammatory condition of the lung airways resulting in episodic airflow obstruction

Asthma

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Risk factor for persistent asthma in childhood

1) Injurious viral infection of the airways that manifest as pneumonia or bronchiolitis 2) Allergen in children

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Approximately 80% of all asthmatic patients report disease onset prior to age of

6 years

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Major risk factors that predict asthma

1) Parent asthma 2) Inhalant allergen sensitization

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Minor risk factors that predict asthma

1) Allergic rhinitis 2) Wheezing apart from colds 3) >/4% neutrophils 4) Food allergen sensitization

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2 main types of childhood asthma

1) Recurrent wheezing in childhood 2) Chronic asthma associated with allergy 3) In females who are obese and had early onset puberty (11 y/o)

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Recurrent wheezing in childhood is primarily triggered by

Common viral infections of the respiratory tract

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Type of asthma that persists into later childhood and adulthood

Chronic asthma

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Mc chronic symptoms of asthma

1) Dry coughing 2) Expiratory wheezing

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Mild vs Moderate vs Severe Asthma Exacerbation: Breathlessness while walking

Mild

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Mild vs Moderate vs Severe Asthma Exacerbation: Breathlesness at rest

Moderate-Severe

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Mild vs Moderate vs Severe Asthma Exacerbation: Sits upright

Severe

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Mild vs Moderate vs Severe Asthma Exacerbation: Prefers sitting

Moderate

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Mild vs Moderate vs Severe Asthma Exacerbation: Can lie down

Mild

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Mild vs Moderate vs Severe Asthma Exacerbation: Talks in phrases

Moderate

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Mild vs Moderate vs Severe Asthma Exacerbation: Talks in sentences

Mild

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Mild vs Moderate vs Severe Asthma Exacerbation: Talks in words

Severe

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Mild vs Moderate vs Severe Asthma Exacerbation: May be agitated

Mild

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Mild vs Moderate vs Severe Asthma Exacerbation: Usually agitated

Moderate-Severe

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Mild vs Moderate vs Severe Asthma Exacerbation: Drowsy or confused

RESPIRATORY ARREST IMMINENT

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Mild vs Moderate vs Severe Asthma Exacerbation: RR>30

Severe

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Mild vs Moderate vs Severe Asthma Exacerbation: Increased RR

Mild-Moderate

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Mild vs Moderate vs Severe Asthma Exacerbation: Use of accessory muscles/suprasternal retractions usually

Severe

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Mild vs Moderate vs Severe Asthma Exacerbation: Use of accessory muscles/suprasternal retractions commonly

Moderate

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Mild vs Moderate vs Severe Asthma Exacerbation: Use of accessory muscles/suprasternal retractions usually not

Mild

Mild vs Moderate vs Severe Asthma Exacerbation: Paradoxical thoracoabdominal breathing

RESPIRATORY ARREST IMMINENT

Mild vs Moderate vs Severe Asthma Exacerbation: Moderate, often end-expiratory wheeze

Mild

Mild vs Moderate vs Severe Asthma Exacerbation: Wheeze loud throughout exhalation

Moderate

Mild vs Moderate vs Severe Asthma Exacerbation: ; Loud throught inhalation and exhalation

Severe

Mild vs Moderate vs Severe Asthma Exacerbation: No wheeze

RESPIRATORY ARREST IMMINENT

Mild vs Moderate vs Severe Asthma Exacerbation: PR less than 100

Mild

Mild vs Moderate vs Severe Asthma Exacerbation: PR 100-120

Moderate

Mild vs Moderate vs Severe Asthma Exacerbation: >120

Severe

Mild vs Moderate vs Severe Asthma Exacerbation: Bradycardia

Respiratory arrest imminent

Mild vs Moderate vs Severe Asthma Exacerbation: Pulsus paradoxus absent

Mild or respiratory arrest imminent

Mild vs Moderate vs Severe Asthma Exacerbation: Pulsus paradoxus may be present

Moderate

Mild vs Moderate vs Severe Asthma Exacerbation: Pulsus paradoxus often present

Severe

Mild vs Moderate vs Severe Asthma Exacerbation: PEF >/70%

Mild

Mild vs Moderate vs Severe Asthma Exacerbation: PEF less than 25%

Respiratory arrest imminent

Mild vs Moderate vs Severe Asthma Exacerbation: PEF ~40-69%

Moderate

Mild vs Moderate vs Severe Asthma Exacerbation: PEF less than 40%

Severe

Mild vs Moderate vs Severe Asthma Exacerbation: PEF response lasts less than 2 hours

Moderate

Mild vs Moderate vs Severe Asthma Exacerbation: PaO2 >/60mmHg

Moderate

Mild vs Moderate vs Severe Asthma Exacerbation: PaO2 less than 60%

Severe

Mild vs Moderate vs Severe Asthma Exacerbation: PaO2 normal

Mild

Mild vs Moderate vs Severe Asthma Exacerbation: PCO2 >/42mmHg

Severe

Mild vs Moderate vs Severe Asthma Exacerbation: PCO2 less than 42 mmHg

Mild or Moderate

Mild vs Moderate vs Severe Asthma Exacerbation: SaO2 90-95%

Moderate

Mild vs Moderate vs Severe Asthma Exacerbation: SaO2 >95%

Mild

Mild vs Moderate vs Severe Asthma Exacerbation: SaO2 less than 90%

Severe

Objective measure of airflow limitation

Spirometry

Spirometry is feasible only in children at what age

>6 y/o

If the FEV1 is within ___%, then the highest of 3 attempts is used

An FEV1/FVC ratio of ___ indicates significant airflow obstruction

Less than 0.80

Bronchodilator response with asthma

FEV1 >/12% and >/200mL

Components of asthma assessment and monitoring

1) Disease activity 2) Control 3) Responsiveness to therapy

Refers to the intrinsic intensity of the disease (asthma) which directs the initial level of therapy and assessed only once

Severity (Intermittent; mild, moderate, or severe persistent)

Degree to which symptoms, ongoing functional impairments, and risk of adverse events are minimized and goals of therapy are met

Asthma control (well-controlled, not well-controlled, poorly-controlled)

Components of asthma management

1) Assessment and monitoring of activity 2) Provision of education to enhance knowledge and skills for self-management 3) Identification and management of precipitating factors and co-morbid conditions 4) Appropriate selection of medications

Components of asthma severity

1) Daytime symptoms 2) Nighttime awakenings 3) SABA use 4) Interference with normal activity 5) Lung function (FEV1 and FEV1: FVC) 6) Exacerbations requiring systemic steroids

Preferred treatment for all patients with persistent asthma

Daily ICS therapy

If a child has had well-controlled asthma for at least ___ months, guidelines suggest decreasing dose or number of child's controller meds

MC encountered adverse events of ICS

LOCAL: 1) Oral candidiasis 2) Dysphonia

MOA of Zileuton

Leukotriene synthesis inhibitor

Zileuton is not approved for children less than or equal to ___ y/o

MOA of Omalizumab

Monoclonal Ab that binds IgE thereby preventing its binding to the high-affinity IgE receptor and blocking IgE-mediated allergic response

Define status asthmaticus

A severe exacerbation of asthma that does not improve with standard therapy

Best predictor of future life-threatening asthma exacerbations or a fatal asthma episode

Severe asthma exacerbation resulting in respi distress, hypoxia, hospitalization, and/or respi failure

Home "rescue" medication for asthma

Inhaled SABA q20min x 3

If the child has incomplete response to rescue medications (SABA q20mins x 3), what to do next

Short course oral ICS therapy (Prednisone 1-2 mkday) for 4 days in addition to inhaled beta agonist therapy

Discharge criteria for asthma

1) Sustained improvement of symptoms 2) Normal PE 3) PEF >70% of predicted or personal best 4) O2sat >92% on RA for 4 hours

Predictive of asthma persistence in adulthood

Asthma severity by 7-10 years old

Prolonged breastfeeding of how many months is found to reduce likelihood of asthma development

>4 months