Pediatric Asthma Flashcards
asthma is-
- a disease of DIFFUSE, CHRONIC airway inflammation = acute exacerbation
- characterized by hyperresponsiveness and airway obstruction
- partially reversible
- intermittent, recurrent symptoms
transient wheezers:
- associated with LRTI
- no wheezing after age 3yr
- inc incidence of RSV infections
- “nonatopic” wheezers
- inc airway reactivity
Atopic wheezers
most likely to dev persistent asthma
- elevated IgE levels - prone to allergen mediated airway hyperresponsiveness
- more profound lung function deficits
Pathophys of asthma:
1) bronchoconstriction
2) edema
3) inc mucus production
4) airway remodeling (chronic)
diagnosis of asthma:
- recurrent episodes of airway obstruction or hyperresponsiveness
- at least partially reversible
- exclude alternate diagnoses
clinical symptoms:
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
History to ask for asthma?
- pattern of symptoms?
- triggers/factors?
- Hx of recurrent wheezing/coughing?
Spirometry tsting:
- only useful/reliable in children 5 yr +
- FEV112%)
Lab for asthma?
not very useful
-Suggestive: eosinophilia; elevated serum IgE
Chest X-ray why?
Get baseline!
Vocal cord dysfunction
- adolescents
- no response to asthma meds
- flat inspiratoy loop of PFTs
- adduction vocal cords with inspiration
Psychogenic cough
- increased with stress
- inc with attention to cough
- *-absent during sleep**
- brassy or honking in quality
ASthma risk index:
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
Categories of asthma severity:
1) intermittent
2) mild persistent
3) moderate persistent
4) severe persistent
*intermitent persistent asthma:
- <=2days/week & 0 nights/mo
- NO problems with normal activity
- RISK: 0 to 1/year
- Step1 tx: SABA PRN
*mild persistent asthma
- 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
*moderate persistent asthma
- 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
*severe persistent asthma:
- 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
*Intermittent to persistent asthma change:
2 canisters per month
2 coughing fits per month
albuterol inhalor more than 2x per week
Long term asthma management goals:
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
Tx for asthma kids:
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)
Medical management of asthma:
- All patient with PERSISTENT systems need long term control meds (taken daily to reduce inflammation)
- Quick relief meds
Long term meds
- inhaled corticosteroids (used with a spacer)
- leukotriene mods
- long acting beta 2 agonists
Inhaled corticosteroids:
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
