Pediatric Asthma Flashcards
Asthma is characterized by
___ or persistent
symptoms, such as dyspnea, chest tightness, wheezing, sputum production and cough associated wi t h variable airflow limitation and airway hyperresponsiveness to endogenous or exogenous stimuli
paroxysmal
pathophysiology of asthma
inflammation, bronchoconstriction, mucus hypersecretion
asthma is a multifactorial polygenic disease. They have gene-envirnoment interactions .What are prenal risk factors?
- tobacco- risk for atopy and airway resistance/obstruction.
- • If maternal GM smoked, 1.8x risk
even if mother did not smoke! -
affect on ova?
post natal risk factors for asthma development
- tobacco
- viral infections (RSV, rhinovirus)
- indoor/outdoor pollution: Fire, gas stroves, diesel.
- pre-pubertal obesity
protective factors for asthma
- animals: cows, cars, dogs
daycare in infancy, siblings
intermittent asthma is more random with little family histoyr of atopic asthma. asymptomatic between episodes. symptoms with URTIs.
- ___ inflammation seen.
- tend to “grow out of symptoms” around age __
neutrophilic inflammation
- “grow out of symptoms” around age 5
persistant asthma- aka ___-associated asthma aka __ asthma
IgE associated wheezers/ atopic asthma (usually has exzema)
“classic history “ of asthma
relief with beta agonist
red flags if your considering asthma
asthma does not cause growth failure– if there is GF, consiedr other symptoms. celiac disease is heavily correlated with asthma too but they shouldnt have chronic diarrhea
atopic findings on physical examination
May have atopic findings
• allergic shiners
• allergic salute
• eczema
- expiratory wheeze
T/F severe asthma can cause finger clubbing
false
T/F severe asthma can cause. Subconjunctival Hemorrhage
false.
T/F severe asthma can cause nasal polyps
possible— but definitely not pre-pubertal
investigations to asthma
• None… • Trial of therapy
• Pulmonary function testing
• Spirometry, post-bronchodilator response, +/
lung volumes
- Less commonly:
- Methacholine bronchoprovocation • Exercise bronchoprovocation
spirometry findings for a kid >6 with asthma
- FEVl < 80%pred
- FEVl/FVC < 80%
- FEVl > 12% post-SABA
- (Do not require >200ml unlike adults)
- may also be normal
Other tests
Guided by history & physical exam if red flags
Guided by history & physical exam if red flags
• Chest X-ray • Sweat test •Immunefunction • Barium s wallow • Bronchoscopy
management of asthma
educate- empower parents to recognize symptoms of inadequate control. Understant pathophysiology, medications, device technique, action plan
T/F carpet removal and HEPA filters can help mediate the astham exacerbations
false. But it might be helpful if youre tracking in a lot of debris from outside to reduce dust. longterm there’s no conclusions though
• Controller/preventative= anti-inflammatory pharmacologic therapy
- Inhaled corti cost er oids (ICS)
- Leukotriene receptor antagonists (LTRA)
- Combination t h e r a p y - ICS + LABA
- Anti-lgE - omalizumab
• Reliever/Rescue= bronchodilator pharmacologic therapy
- Short-acting beta-agonists (SABAs)
- (Anticholinergics)
• First-line therapy for persistent asthma
- VERY effective - can control majority of childhood
asthma with low to moderate doses
inhaled corticosteroids
___ ___ can occur if there are high doses of ICS being used
adrenal suppression.
most inhalers for children <6 have to be:
metered dose inhalers with valved holding chamber
Long-acting Beta-agonists (LABA) should only be used in combination with ____
ICS.
this is not a first line therapy. it’s 2 or 3rd line
approved anti-igE medication for children 6-12 years
1.Anti-lgE Omalizumab (“Xol air”)
Tx of Acute Exacerbations
Criteria for Admission for pediatric Acute Exacerbations
T/F ABG should be performed when child presents with acute asthma exacerbation
false. no role for ABG in the conscious child.
Treatment for pediatric acute exacerbation
- most will not require admission
- bonchodilators
- oral corcticosteroids: prednisone, dexamethasone.
Admitted patients treatment for asthma : Aggressive early treatment with gradual
reduction of ____s over 24-48 hours, PLUS OXYGEN and systemic steroids if tolerated.
Aggressive early treatment with gradual
reduction of B-agonists over 24-48 hours
Criteria for ICU admission
- Continued requirement for___ > hourly
- assume this child will need ___
- this patient should be ___
- this child should have an intravenous access
- the ICU staff should be aware
- Continued requirement for B-agonist > hourly
- assume this child will need intubation
- this patient should be NPO • this child should have an intravenous
- the ICU staff should be aware
- Evidence of fatigue
outline the treatment pyramid for asthma
pyramid for 6 years and over. ICS, then with combo LTRA.
now, ICS/formoterol (long acting beta agonistLABA) now preferred reliever across all severities– but this isn’t yet encorporated in the diagram
