Lower Airway Obstruction Flashcards
Lower Airway Obstruction
Bronchiolitis
Asthma
1st 2 years of life
RSV
prodrome of cough, colds, fever
CXR - not routine
BRONCHIOLITIS
Chronically inflamed airways and increased production of mucus
NOCTURNAL cough
Bronchospasm
WHEEZING
ASTHMA
Signs of Lower Airway Obstruction
tachypnea
wheezing - EXPIRATORY
increased respiratory effort
PROLONGED EXPIRATORY PHASE
cough
MC trigger of asthma in children
VIRAL URTI
CXR findings in bronchiolitis and asthma
Hyperinflation
Atelectasis (+/-)
Infiltrates
GINA Guidelines/PAPP 2021
Classify based on Severity
Intermittent
Persistent (mild, moderate, severe)
Classify levels of asthma control
Uncontrolled
Partly controlled
Controlled
Consider hospital admission in asthma when patient has any of the ff clinical criteria
use of >6-8 SABA puffs in the past 24 hrs
PEF 50-75% of personal best
history of severe exacerbations warranting ICU admission
hospital admission or previous exacerbations for the past 12 mos
WHO Resting RR (Normal for age)
1 mo - 12 mo - < 50
1-5 y/o - < 40
6-10 y/o - < 30
11-18 y/o - < 20
Target O2 sat for 6-11 y/o with asthma
94-98%
Target O2 sat for adolescents with asthma
93-95%
O2 sat that is a predictor of HOSPITALIZATION
92%
O2 sat that warrants AGGRESSIVE THERAPY
90%
Patients not on controller meds should be started on
regular ICS containing Tx
The most cost effective delivery (inhaler)
delivery via pMDI
pMDI plus spacer with face mask
0-3 years
pMDI plus spacer with mouthpiece
4-5 years
Systemic Corticosteroids
Prednisone/Prednisolone
Methylprednisolone
Dexamethasone
Should be given to prevent future severe exacerbations and hospitalizations and to reduce deaths
Inhaled corticosteroids
For moderate to severe exacerbations across all ages – greater improvement in lung function and fewer hospitalizations
Ipratropium bromide
NOT routinely given for acute exacerbation
Add on treatment in the 1st hour in severe exacerbations
Magnesium sulfate
Level of Asthma Symptom Control
Well controlled - 0
Partially controlled - 1-2
Uncontrolled - 3-4
Symptoms less than 2x a month
PREFERRED CONTROLLER
low dose ICS whenever SABA is taken
RELIEVER
as needed SABA or low dos ICS-formoterol reliever for MART
Symptoms 2x a month or more but less than daily
PREFERRED CONTROLLER
daily low dose ICS
RELIEVER
as needed SABA or low dos ICS-formoterol reliever for MART
Symptoms most days or waking at night once or more in a week
PREFERRED CONTROLLER
daily low dose ICS-LABA or medium dose ICS or very low dose MART (ICS-formoterol)
RELIEVER
as needed SABA or low dos ICS-formoterol reliever for MART
Symptoms most days or waking at night once a week and/or low lung function
PREFERRED CONTROLLER
medium dose ICS-LABA or low dose ICS formoterol MART or refer
RELIEVER
as needed SABA or low dos ICS-formoterol reliever for MART
(+) wheezing
hx of viral infection among the family members
2 y/o
Bronchiolitis
(+) wheezing
hx of atopy in the family
recurrent wheezing especially after mild viral infection or exercise
Asthma
(+) wheezing
wheezes are heard loudest over the trachea
persistent wheezing never seems to go way
Chondromalacia
(+) wheezing
(-) breath sounds R lung
3 y/o
Foreign Body Airway Obstruction
4 things to check about asthma control
daytime symptoms more than 2x a week
night walking
need for reliever > 2x a week
activity limitation
Preferred reliever for adolescents w/ asthma
ICS-formoterol
MCC of stridor in infants and children
Laryngomalacia
Differentiates PCAP-B from PCAP-A
Malnutrition
Comorbid conditions
Respiratory signs present in PCAP D but not in PCAP C
Cyanosis
Grunting
Apnea
MCC of pneumonia in children worldwide
Viruses
