Nelsons Flashcards
Major childhood risk factors for persistent asthma
Parent asthma
Eczema
Inhalant allergen sensitization
Minor risk factors for persistent asthma
Allergic rhinitis
Wheezing apart from colds
>4% peripheral blood eosinophils
Food allergen sensitization
strongest identifiable factor for persistence of childhood asthma
Allergy in young children with recurrent cough and/or wheeze
Differentials for asthma
GER
Rhinosinusitis
Early life:
Tracheobronchomalacia
Older:
Vocal cord dysfunction
Can help confirm diagnosis of asthma and determine severity
Lung Function test
Essential assessment tool in children who are at risk for severe asthmaexacerbations and those who have poor perception of asthma symptoms
Spirometry
Indicates airflow obstruction
FEV1/FVC of <0.80
Diagnostic findings of asthma in PEF
Diurnal variation in PEF >20% is consistent with asthma
On Asthma control test, what does the scores mean? (For adults)
ACT >/=20 well controlled asthma
16-19 not well controlled
= 15 very poorly controlled
Childhood ACT (C-ACT)
ACT >/=20 well controlled asthma
13-19 not well controlled
=12 very poorly controlled
Asthma medication not intended for use as monotherapy for persistent asthma because it can increase the risk of serious asthma exacerbations
LABA
Management of Asthma in ED
Initial:
Supplemental O2
Inhaled SABA every 20 mins for 1hr
If necessary either oral or IV systemic corticosteroids
*single oral, IM or OV of Dexa 0.6mg/kg has been found to be effective alternative to perdnisone
Discharge medications in asthma after ED
Inhaled beta agonist up to every 3-4hr plus 3-7 day course of OCS
Hospital management of asthma
Supplemental oxygen
Frequent and continuous administration of inhaled bronchodilator
Systemic corticosteroid
Patients who received >2 weeks of systemic corticosteroid and/or moderate to high dose ICS may be at risk for
Intraoperative adrenal insufficiency
