pediatric asthma Flashcards
asthma is characterized by _____responsiveness and airway obstruction
hyperresponsiveness
wheezing assc’d with LRTI, no wheezing after age 3
transient wheezing
wheezing assc’d with incr airway reativity, incr incidence of RSV infxn, persistent wheezing after age 3
nonatopic wheezing
those w/ elevated IgE levels, profound lung deficits, most likely to develop persistent asthma
atopic wheezers
what to expect in acute exacerbation of asthma?
incr AP diameter, pulsus paradoxus, nasal flaring, palpable liver & spleen
what are some signs of atopy in acute exacerbation?
atopic dermatitis, allergic rhinitis
how to tx acute exaceration of asthma?
albuterol + ipratropium bromide
spirtometry is only useful in children age____
5 and older
when to do a CXR if you suspect asthma
need a baseline CXR
what sort of changes will you see on CXR?
hyperinflation, bronchial thickening, atelactasis, pneumothorax
DDX for asthma: adolescent,s no response to asthma meds, flat inspiratory loop on PFT, adduction of vocal cords with inspiration
vocal cord dysfxn
DDX for asthma: incr with stress, absent during sleep, brassy in quality
psychogenic cough
what are major risk factors for asthma (3)
- parental h/o asthma
- atopic dermatitis
- sensitization to aeroallergen
categories of asthma severity (4)
- intermittent
- mild persistent
- moderate persistent
- severe persistent
what category: less than 2 days per week with sx, never sx at night
intermittent category
how to tx intermittent asthma?
short acting beta agonists as needed
how should patients with persistent sx be tx’d?
all patients with persistent sx should be started on long term controller meds (inhaled corticosteroid)
how long does the full effect of inhaled corticosteroids take?
4 weeks
if you have a moderate to persistent asthmatic that is poorly controlled, then how to tx?
long acting beta 2 agonists
how should long acting beta agonists NOT be used?
do NOT use as monotherapy, do NOT use for acute exacerbations
what to use in acute moderate/severe exacerbations in emergency care setting?
can add ipratropium bromide to short acting beta 2 agonist
in what sort of setting is ipratropium bromide used?
urgent care, ED (NOT outpatient or inpatient)
how often to assess spirometry?
initially, then every 1-2 yrs
