Chronic Respiratory- Peds Flashcards

1
Q

atopic dermatitis (ezcema)

A
  • Loss of function in the epidermal barrier
    o Due to environmental exposures: climate, air pollution, water hardness and early exposure to nonpathogen microorganisms.
    o Alteration of cutaneous microbiome
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2
Q

atopic dermatitis (eczema): risk factors

A

o Genetics: family hx of atopic dermatitis, asthma or allergic rhinitis.

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3
Q

atopic dermatitis: s/s

A

o In children/adults with deeply pigmented skin, erythema may appear dark brown or violaceous instead of pink/red, as typically seen in patients with less/lighter pigmentation in their skin.
o Typically appears on extensor surfaces in younger children, whereas it is the flexural surfaces in older children/adults.
o Dry skin
o Severe pruritis

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4
Q

chronc/subacute eczema

A

 Dry, scaly, excoriated/erythematous papules
 Skin thickening (lichenification) or fissures from scratching

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5
Q

acute eczema

A

 Intensely pruritic, erythematous papules and vesicles with exudates/crusting

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6
Q

tx atopic dermatitis

A

o Showering/bathing daily: unscented dove bar soap to help remove any irritants/allergens on the skin
* Drip dry, do not rub dry with towel: friction on skin can be irritating
* While still moist, should apply topical steroids/creams and lotions, to help lock-in moisture
o Unscented lotions: Lubriderm, Cetaphil, Aveeno, Aquaphor
o Wet pajamas
o Daily antihistamines can help with underlying histamine response; combination of both long-acting and short-acting works best
o Swimming in a swimming pool vs. bleach baths
* 1 cup of baking soda/bleach for ½ tub full of water: soak in the bath for 10-15 minutes, then rinse well. (recommended daily for at least 3x/week
o Long-acting non-drowsy
* Loratidine
* Cetirizine
* Levocetirizine
* Fexofenadine
o Short-acting drowsy (Recommend nightly before bed)
* Diphenhydramine
* Hydroxyzine
o Topical steroids
* Group 1 is highest potency and group 7 is lowest. You want to start with the lowest potency and work your way up.
* Hydrocortisone 2.5% is most commonly prescribed but not great for the face. (lowest)
* Triamcinolone is okay to use on the face (step up from Hydrocortisone)
* Thins the skin so don’t want to be on it too long (2 weeks max)

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7
Q

allergic rhinitis (seasonal allergies): s/s

A

o Clear rhinorrhea
o Boggy nasal turbinates
o Sneezing
o Allergic salute– When patients rub their nose due to itching/running
o Allergic shiners– Dark circles under the eyes caused by congestion of nose/sinuses
* Treatment:
o Long-acting daily antihistamines
o Short-acting daily antihistamines

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8
Q

tx of allergic rhinits

A

o Daily short acting and long-acting antihistamines
o Nasal sprays
* Flonase: Fluticasone Furoate (27.5 mcg/spray)/Fluticasone Propionate (50mcg/spray): intranasal steroid
* Start with 1 spray in each nostril twice daily to manage symptoms; once controlled:
o Can drop to 1-2 sprays in each nostril daily
* Mometasone
* Children under 12: 1 spray in each nostril daily
* Children over 12: 1 spray in each nostril twice daily
* Cromolyn (sodium cromoglycate)
* Not absorbed systemically; good choice for parents concerned about potential side effects of other medications, who are willing to administer something regularly.
* Nasal saline
* Follow instructions on the box; no limit to how many times per day to be used.

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9
Q

asthma

A
  • A condition where airways become inflamed, narrow and swell and produce extra mucus, making it difficult to breath: due to a trigger
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10
Q

asthma: s/s

A

difficulty breathing, chest pain, cough and wheezing

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11
Q

asthma: triggers

A

environmental, food, climate, exposure to second-hand smoke

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12
Q

classifying asthma

A

o Step 1: Mild Intermittent
* Symptoms fewer than twice/week
* No issues between flares (flares are short: a few hours-a few days)
* Nighttime symptoms: less than twice/month
o Step 2: Mild Persistent Asthma
* Symptoms 2+ times/week, but no more than once daily
* Activity levels may be affected by flares
* Nighttime symptoms: 2+/month
o Step 3: Moderate Persistent Asthma
* Symptoms daily
* Uses rescue (SABA) daily
* Has flares 2+ times/week
* Activity levels may be affected by flares
* Nighttime symptoms 1+/week
o Step 4: Severe Persistent Asthma
* Constant symptoms
* Decrease in physical activity
* Frequent flares
* Nighttime symptoms frequently

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13
Q

how to use a peak flow meter

A
  • 1: place the marker at the bottom of the scale
  • 2: stand up/sit up straight
    1. Take a deep breath
    1. Put the meter in the mouth and close lips around mouthpiece. Do not put tongue inside the hole. Do not cover the hole on the back end of the PFM when holding it
  • 5: Blow out as hard/fast as possible. Don’t cough/huff into the PFM, as this will give a false reading.
  • 6: write down the number from the meter
  • 7: Repeat steps 1-6 two more times
  • 8: Write the highest of the 3 numbers in your child’s peak flow diary every day/as instructed
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14
Q

how to measure spirometry

A
  • FEV: forced expiratory volume (how much you can exhale during a forced breath)
  • FVC: forced vital capacity (total amount of air you can exhale forcefully in one breath)
  • FEV1: amount of air you can force from your lungs (exhale) in one second.
    o Greater than 80% of predicted= normal
    o 65%-79% of predicted= mild obstruction
    o 50%-64% of predicted= moderate obstruction
    o Less than 50% predicted= severe obstruction
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15
Q

Why not treat with SABA alone in 12+

A
  • Inhaled SABA baseline treatment for asthma for the past 50 years:
    o Asthma was thought to be a disease of bronchoconstriction
    o Role of SABA reinforced by rapid relief of symptoms and low cost
  • Use of SABA is still necessary for those with breakthrough symptoms on a daily ICS (SABA=rescue med; ICS=maintenance)
  • Regular use of SABA, even for 1–2 weeks, is associated with increased AHR, reduced bronchodilator effect, increased allergic response, increased eosinophils
    o Can lead to vicious overuse cycle
    o SABA use only lead to increased exacerbations and mortality
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16
Q

Children 5 years or younger

A

o Step 1–ICS (but not used daily for only at times when they are sick) and SABA
* Bc you don’t want to stunt their growth with ICS
* Once their illness is over they can stop using the ICS and can go back to just using their SABA
* Mild persistent asthma
o Step 2– when you would start using the ICS for them

17
Q

Children 6-11

A
  • Mild intermittent asthma
    o Step 1– anytime they are taking a SABA you want them to take ICS
  • Mild persistent asthma
    o Step 2– you would use the ICS daily
18
Q

children 12 and older

A
  • Mild intermittent asthma
    o Step 1 start with ICS and use low dose reliever if they need it
19
Q

severe asthma guide

A
  • Anti-IL4R* (dupilumab) for severe eosinophilic/Type 2 asthma
    o Not suggested if blood eosinophils (current or historic) >1500/µl
    o Dupilumab now also approved for children ≥6 years with severe eosinophilic/Type 2 asthma, not on maintenance OCS (Bacharier, NEJMed 2021)
  • Anti-TSLP* (tezepelumab) now approved for severe asthma (age ≥12 years)
    o Greater clinical benefit with higher blood eosinophils and/or higher FeNO
    o Insufficient evidence in patients taking maintenance OCS
20
Q

Asthma Action Plan

A
  • This is where you would put your FEV1s
  • Green zone: 80 and above–means that their asthma is well controlled
  • Yellow zone: 60-80–asthma not as well controlled
  • Red zone: seek doc right away! Poorly controlled asthma
21
Q

anaphylaxis

A
  • Anaphylaxis is a potentially fatal disorder if undertreated. Therapy should begin with early recognition and treatment with epinephrine to prevent progression of life-threatening respiratory and/or cardiovascular symptoms and signs, including shock.
  • Remember ABCs (Airway, Breathing, Circulation)!!
  • 2 or more systems involved, should automatically be treated as anaphylaxis
22
Q

anaphylaxis: s/s

A

o Angioedema of the mouth/lips/tongue/throat
o Wheezing/coughing
o Hives/rash
o Vomiting/Diarrhea

23
Q

tx of anaphylaxis

A

o Epinephrine–Can be given every 3-5 minutes
o Albuterol
o H1 antihistamine:
* Diphenhydramine
* Cetirizine
* Cetirizine
o H2 blocker:
* Famotidine
o Glucocorticoid:
* Methylprednisolone