Pediatric Asthma

Question 1

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

Answer 1

paroxysmal

Question 2

pathophysiology of asthma

Answer 2

inflammation, bronchoconstriction, mucus hypersecretion

Question 3

asthma is a multifactorial polygenic disease. They have gene-envirnoment interactions .What are prenal risk factors?

Answer 3

1. tobacco- risk for atopy and airway resistance/obstruction.

• • If maternal GM smoked, 1.8x risk
  even if mother did not smoke! -
  affect on ova?

Question 4

post natal risk factors for asthma development

Answer 4

1. tobacco
2. viral infections (RSV, rhinovirus)
3. indoor/outdoor pollution: Fire, gas stroves, diesel.
4. pre-pubertal obesity

Question 5

protective factors for asthma

Answer 5

• animals: cows, cars, dogs

daycare in infancy, siblings

Question 6

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 __

Answer 6

neutrophilic inflammation

• “grow out of symptoms” around age 5

Question 7

persistant asthma- aka ___-associated asthma aka __ asthma

Answer 7

IgE associated wheezers/ atopic asthma (usually has exzema)

Question 8

“classic history “ of asthma

Answer 8

relief with beta agonist

Question 9

red flags if your considering asthma

Answer 9

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

Question 10

atopic findings on physical examination

Answer 10

May have atopic findings
• allergic shiners
• allergic salute
• eczema

• expiratory wheeze

Question 11

T/F severe asthma can cause finger clubbing

Answer 11

false

Question 12

T/F severe asthma can cause. Subconjunctival Hemorrhage

Answer 12

false.

Question 13

T/F severe asthma can cause nasal polyps

Answer 13

possible— but definitely not pre-pubertal

Question 14

investigations to asthma

Answer 14

• None… • Trial of therapy

• Pulmonary function testing
• Spirometry, post-bronchodilator response, +/
lung volumes

• Less commonly:
• Methacholine bronchoprovocation • Exercise bronchoprovocation

Question 15

spirometry findings for a kid >6 with asthma

Answer 15

• FEVl < 80%pred
• FEVl/FVC < 80%
• FEVl > 12% post-SABA
• (Do not require >200ml unlike adults)
• may also be normal

Question 16

Other tests
Guided by history & physical exam if red flags

Answer 16

Guided by history & physical exam if red flags
• Chest X-ray • Sweat test •Immunefunction • Barium s wallow • Bronchoscopy

Question 17

Question 18

management of asthma

Answer 18

educate- empower parents to recognize symptoms of inadequate control. Understant pathophysiology, medications, device technique, action plan

Question 19

T/F carpet removal and HEPA filters can help mediate the astham exacerbations

Answer 19

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

Question 20

• Controller/preventative= anti-inflammatory pharmacologic therapy

Answer 20

• Inhaled corti cost er oids (ICS)
• Leukotriene receptor antagonists (LTRA)
• Combination t h e r a p y - ICS + LABA
• Anti-lgE - omalizumab

Question 21

• Reliever/Rescue= bronchodilator pharmacologic therapy

Answer 21

• Short-acting beta-agonists (SABAs)
• (Anticholinergics)

Question 22

• First-line therapy for persistent asthma
- VERY effective - can control majority of childhood
asthma with low to moderate doses

Answer 22

inhaled corticosteroids

Question 23

___ ___ can occur if there are high doses of ICS being used

Answer 23

adrenal suppression.

Question 24

most inhalers for children <6 have to be:

Answer 24

metered dose inhalers with valved holding chamber

Question 25

Question 26

Long-acting Beta-agonists (LABA) should only be used in combination with ____

Answer 26

ICS.

this is not a first line therapy. it’s 2 or 3rd line

Question 27

approved anti-igE medication for children 6-12 years

Answer 27

1.Anti-lgE Omalizumab (“Xol air”)

Question 28

Question 29

Tx of Acute Exacerbations

Answer 29

Question 30

Criteria for Admission for pediatric Acute Exacerbations

Answer 30

Question 31

T/F ABG should be performed when child presents with acute asthma exacerbation

Answer 31

false. no role for ABG in the conscious child.

Question 32

Treatment for pediatric acute exacerbation

Answer 32

• most will not require admission
• bonchodilators
• oral corcticosteroids: prednisone, dexamethasone.

Question 33

Question 34

Admitted patients treatment for asthma : Aggressive early treatment with gradual
reduction of ____s over 24-48 hours, PLUS OXYGEN and systemic steroids if tolerated.

Answer 34

Aggressive early treatment with gradual
reduction of B-agonists over 24-48 hours

Question 36

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

Answer 36

• 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

Question 37

outline the treatment pyramid for asthma

Answer 37

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