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Respiratory 1 > Pediatric Asthma > Flashcards

Pediatric Asthma Flashcards

1
Q

asthma is-

A
  • a disease of DIFFUSE, CHRONIC airway inflammation = acute exacerbation
  • characterized by hyperresponsiveness and airway obstruction
  • partially reversible
  • intermittent, recurrent symptoms
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2
Q

transient wheezers:

A
  • associated with LRTI
  • no wheezing after age 3yr
  • inc incidence of RSV infections
  • “nonatopic” wheezers
  • inc airway reactivity
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3
Q

Atopic wheezers

A

most likely to dev persistent asthma

  • elevated IgE levels - prone to allergen mediated airway hyperresponsiveness
  • more profound lung function deficits
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4
Q

Pathophys of asthma:

A

1) bronchoconstriction
2) edema
3) inc mucus production
4) airway remodeling (chronic)

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5
Q

diagnosis of asthma:

A
  • recurrent episodes of airway obstruction or hyperresponsiveness
  • at least partially reversible
  • exclude alternate diagnoses
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6
Q

clinical symptoms:

A

1) cough
- gets worse at night
- usually only symptom
2) wheezing
- high-pitched whistling sounds on expiration
3) SOB
4) chest tightness
5) abdominal pain
6) vomiting
7) onset depends on triggers=acute or gradual

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7
Q

History to ask for asthma?

A
  • pattern of symptoms?
  • triggers/factors?
  • Hx of recurrent wheezing/coughing?
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8
Q

Spirometry tsting:

A
  • only useful/reliable in children 5 yr +

- FEV112%)

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9
Q

Lab for asthma?

A

not very useful

-Suggestive: eosinophilia; elevated serum IgE

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10
Q

Chest X-ray why?

A

Get baseline!

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11
Q

Vocal cord dysfunction

A
  • adolescents
  • no response to asthma meds
  • flat inspiratoy loop of PFTs
  • adduction vocal cords with inspiration
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12
Q

Psychogenic cough

A
  • increased with stress
  • inc with attention to cough
  • *-absent during sleep**
  • brassy or honking in quality
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13
Q

ASthma risk index:

A

1) children with 4 or more episodes wheezing/year
- last>1 day
- affect sleep
2) most likely asthma with
- 1 or more risk factors: parental hx, atopic dermatitis, sensitization to aeroallergens
- 2 minor risk factors: sensitization to foods, >4% eosinophils, wheezing not associated with URIs

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14
Q

Categories of asthma severity:

A

1) intermittent
2) mild persistent
3) moderate persistent
4) severe persistent

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15
Q

*intermitent persistent asthma:

A
  • <=2days/week & 0 nights/mo
  • NO problems with normal activity
  • RISK: 0 to 1/year
  • Step1 tx: SABA PRN
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16
Q

*mild persistent asthma

A
  • 3-6days/week & 1-2nights/mo
  • minor limitation with normal activity
  • RISK: 2 or more/6mo or >=4 episodes of wheezing/yr with risk ractors for asthma
  • Tx: low dose ICS
17
Q

*moderate persistent asthma

A
  • daily & 3-4nights/mo
  • some limitation with normal activity
  • RISK: 2 or more/6mo or >=4 episodes of wheezing/yr with risk ractors for asthma
  • Tx: med dose ICS and consider short course OCS
18
Q

*severe persistent asthma:

A
  • throughout & >1night/week
  • extremely limited with normal activity
  • -RISK: 2 or more/6mo or >=4 episodes of wheezing/yr with risk ractors for asthma
  • Tx: med dose ICS and consider short course OCS
19
Q

*Intermittent to persistent asthma change:

A

2 canisters per month
2 coughing fits per month
albuterol inhalor more than 2x per week

20
Q

Long term asthma management goals:

A

1) reduce impairment
- prevent chronic symptoms
- reduce use of short acting beta2 agonist
- maintain normal lung function
- maintain normal activity level
2) reduce risk
- prevent exacerbation
- minimize need for emergency care or hospitalization
- prevent loss of lung function or reduced lung growth
- minimize adverse effects of therapy

21
Q

Tx for asthma kids:

A

1) annual influenza vaccine
2) smoking cessation in family
3) dec exposure to allergens (pets, dust, cockroaches)
4) treat comorbid conditions (GE reflux, obesity, obstructive sleep apnea, allergies)

22
Q

Medical management of asthma:

A
  • All patient with PERSISTENT systems need long term control meds (taken daily to reduce inflammation)
  • Quick relief meds
23
Q

Long term meds

A
  • inhaled corticosteroids (used with a spacer)
  • leukotriene mods
  • long acting beta 2 agonists
24
Q

Inhaled corticosteroids:

A

1) most effective and consistent
2) long term
3) well tolerated
4) safe
5) MOA: reduce airway inflam
- block late phase inflammatory reaction to allergen (no effec on bronchospasm-early phase reaction)
6) full effects of meds take 4 weeks

25
Q

Adverse effects of inhaled corticosteroids:

A
  • thrush (rinse and spit after use)
  • hoarseness
  • bronchospasm
  • reflex cough
  • dic linear growth velocity (no effect on overall adult height)
26
Q

Leukotriene modifiers:

A

1) interfere with leukotriene mediators released from mast cells, basophils, and eosinophils
2) indications:
- ALTERNATIVE (NOT PREFERRED) for mild persistent asthma
- can be used as adjunct with inhaled corticosteroids
3) less effective as adjunct med that long acting beta2 agonists

27
Q

Long acting beta2 agonists:

A

1) MOA;
-airway beta2 receptor agonist
-inc cAMP concentration
=relaxes airway smooth muscle
2) duration of at least 12 hours
3) NOT USED AS MONOTHERAPY (w/ inhaled corticosteroids)
4) 12years old +

NOT USED AS RESCUE MEDICATIONS!

28
Q

Adverse effects for long acting beta 2 agonists:

A
  • BLACK BOX WARNING

- possible increased risk of exacerbations (NOT USED AS RESCUE MED!)

29
Q

quick relief meds:

A
  • short acting beta2 agonists
  • anticholinergics
  • systemic corticosteroids
30
Q

Short acting beta2 agonists - drugs:

A

-albuterol, levabuterol, pirbuterol

31
Q

Short acting beta 2 agonists:

A

1) MOA:
- prevents airway smooth muscle contraction
- leads to bronchodilation
2) onset/duration:
- effect within minutes of administration
- peak effect 15-30 min
- duration 4-6hours
3) TxX OF CHOICE FOR ACUTE SYMPTOMS
4) Prevents exercise induced bronchospsm

32
Q

Adverse effects - short acting beta2 agonists:

A
  • tachycardia
  • tremor
  • irritability
  • hypokalemia

-if use >2days/week –> poorly controlled asthma

33
Q

Anticholinergics - the drug?

A

-ipratropium bromide = bronhcodilation via muscarinic receptor ( NOT USED OUTSIDE IN OUTPATIET OR HOSPITAL SETTING

34
Q

Anticholinergics -

A

1) MOA-reduce intrinsic vagal tone of airway by inhibiting muscarinic cholinergic receptors
2) additional benefit to short acting beta 2 agonist
- used in acute moderate/severe exacerbations in emergency care setting

35
Q

Systemic corticosteroids: (pregnisoloneand something)

A

1) indications: moderate/severe asthma exacerbations
2) effects:
- improve airway responsiveness
- improve lung function
- dec risk of relapse
3) 4-6 hour onset (MUST GIVE IT EARLY)
4) ORAL is just as good as IV

36
Q

Medication delivery how?

A

always with a spacer
=improves deposition in airways
-less medication deposited in mouth and throat

37
Q

Spirometery how often for monitoring?

A

-every 1-2 years

Respiratory 1 (9 decks)

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