Module 3- Child asthma/Allergic Rhinoconjunctivits Flashcards
Asthma
Most common chronic disease
Effects more boys than girls
Higher percentage amount black children
Children belonging to poor families are more likely affected
Asthma risk factors
Atopy- strongest predisposed factor
Perennial aerial legend
Smoke exposure
Microbiome
Signs and symptoms for asthma
Wheezing, recurrent cough, SOB, chest congestion, prolonged cough, excoriate intolerance, dyspnea,
Prolonged expiration and wheezing on chest auscultation
More severe more high pitched wheezes become
Lab Findings for asthma
Bronchial hyperresponsiveness- can inhale pharmacologic agents to stimulate airway response, reversible airway limitation- measured by reduction in FEV1 and FEV1/FVC and airway inflammation- Clumps of eosinophils on sputum smear and blood eosinophilia
Imaging for asthma
does not need CXR unless ruling out other disease
Conditions that increase asthma severity
chronic hyperplastic sinusitis
GERD
Obesity
psychological/sociological factors
exercise- induced brochospasms
vigorous activity reaches peak 5-10 minutes after stopping and resolves over 20-30 minutes, choice of activity needs to be modified based on severity of illness. SABAs, leukotriene receptor antagonists, cromolyn, nedocromil
Acute asthma general measures
have written action plan- green, yellow and red zones based on symptoms, PEFR cut-off values are conventionally set as > 80% (green), 50%–80% (yellow), and < 50% (red) of the child’s personal best.
Acute asthma- Management at home
Initial treatment should be with a SABA- 2-6 puffs every 20mins up to three times, patient does not completely improve from the initial therapy or PEFR falls between 50% and 80% predicted or personal best, the SABA should be continued, an oral corticosteroid should be added, and the patient should contact the physician urgently
Acute asthma- Management at office/ER
initial FEV1 or PEFR is over 40%, initial treatment can be with a SABA by inhaler, Oral corticosteroids, severe exacerbations or if the initial FEV1 or PEFR is under 40%, initial treatment should be with a high-dose SABA plus ipratropium bromide, 1.5–3 mL every 20 minutes for 3 doses
acute asthma- discharge
sustained response of at least 1 hour to bronchodilator therapy with FEV1 or PEFR greater than 70% of predicted or personal best and oxygen saturation greater than 90% in room air, inhaled SABA and oral corticosteroids should be continued, the latter for 3–10 days, follow up 1 week and have written plan
Allergic Rhinoconjunctivits
most common allergic disease and often coexist with asthma, *Inhalant allergens are primarily responsible for symptoms, *perennial, seasonal (hay fever), or episodic, *intermittent (ie, symptoms present < 4 days a week or for < 4 weeks) and persistent (ie, symptoms present > 4 days a week and for > 4 weeks)
S &S of allergic rhinoconjunctivits
itching of the nose, eyes, palate, or pharynx and loss of smell or taste, Nasal obstruction is associated with mouth breathing, nasal speech, allergic salute, and snoring, Nasal turbinates may appear pale blue and swollen with dimpling or injected with minimal edema, clear and thin nasal secretions are increased, with anterior rhinorrhea, sniffling, postnasal drip, and congested cough, Conjunctival injection, tearing, periorbital edema, and infraorbital cyanosis
Lab findings for allergic rhinoconjuncitivits
Eosinophilia often can be demonstrated on smears of nasal secretions or blood, Skin testing to identify allergen-specific IgE is the most sensitive and specific test for inhalant allergies
Treatment- General measures- ARC
avoidance of causative allergens, nasal irrigation, cold compresses and lubrications
Pharmacologic therapy for intermittent rhinitis
mild intermittent rhinitis includes oral or intranasal H1 antihistamines and intranasal decongestants, moderate-severe intermittent rhinitis are oral or intranasal antihistamines, oral H1 antihistamines and decongestants, intranasal corticosteroids, and cromones,
Pharmacologic therapy for persistent rhinitis
mild persistent rhinitis, reassessment after 2–4 weeks is recommended and treatment should be continued, with a possible reduction in intranasal corticosteroids, even if the symptoms have abated. If, however, the patient has persistent mild symptoms while on H1 antihistamines or cromones, an intranasal corticosteroid is appropriate, moderate-severe persistent disease, use of intranasal corticosteroids as first-line therapy is recommended. For severe nasal congestion, either a short 1- to 2-week course of an oral corticosteroid or an intranasal decongestant for less than 10 days may be added. If the patient improves, the treatment should last for at least 3 months or until the pollen season is over
Pharmacologic therapy for allergic rhinoconjunctivitis
topical nasal corticosteroids also reduce ocular symptoms, presumably through a naso-ocular reflex, ocular allergies which persist or occur independent of rhinitis, pharmacologic treatment includes use of oral or topical antihistamines, topical decongestants, mast cell stabilizers, and anti-inflammatory agents
Antihistamines
help control itching, sneezing, and rhinorrhea, Second-generation antihistamines include loratadine, desloratadine, cetirizine, and fexofenadine are recommend due to lack of drowsiness,
Mast cell stabilizers
Intranasal ipratropium can be used as adjunctive therapy for rhinorrhea. Intranasal cromolyn may be used alone or in conjunction with oral antihistamines and decongestants and is also available in ophthalmic solution
Decongestants and vasoconstrictor agents
Nasal α-adrenergic agents help to relieve nasal congestion and ophthalmic vasoconstrictors relieve ocular erythema, edema, and congestion. Topical nasal decongestants such as phenylephrine and oxymetazoline should not be used for more than 4 days for severe episodes because prolonged use may be associated with rhinitis medicamentosa, oral decongestants do not have convincing data to use
Corticosteroids
Intranasal corticosteroid sprays are effective in controlling allergic rhinitis if used chronically, mometasone, fluticasone, triamcinolone
