pediatric asthma in a nutshell

Question 1

What is asthma?

Answer 1

Disease of airways with inflammation, smooth muscle constriction, mucous production, and edema leading to obstruction and air trapping

Question 2

What is the Asthma Predictive Index (API) used for?

Answer 2

Improve the accuracy of diagnosing chronic asthma in children younger than 3 years old

Question 3

Asthma Predictive Index (API)

Answer 3

Children <3 yo with 3+ wheezing episodes/year:

+1 major criterion: eczema or parental asthma
Or +2 minor criteria: allergic rhinitis, wheezing unrelated to colds, blood eosinophil >4%

Question 4

What is spirometry?

Answer 4

Measures volume and speed of forcibly exhaled air
Used to establish baseline
Should be done at age 6, then every 1-2 years as needed for children with asthma

Question 5

Vocal cord dysfunction

Answer 5

Involuntary closure of vocal cords that typically occurs during exercise

Post-nasal drip and GER can contribute

Question 6

How does vocal cord dysfunction present?

Answer 6

Competitive teen who excels in sports/school
Sudden onset of SOB w/exercise, self-limited
Does not respond to asthma tx, inspiratory stridor

Question 7

How to evaluate for vocal cord dysfunction?

Answer 7

Flexible laryngoscopy

Question 8

Exercise-induced asthma

Answer 8

Bronchoconstriction only with exercise
Starts after exercising, often self-limited
Can pre-treat with SABA

Question 9

Gold standard for diagnosing exercise-induced asthma?

Answer 9

> 10% decrease in FEV1 compared with pre-exercise level

Question 10

Why is sole use of LABAs not recommended for asthma?

Answer 10

Prolonged bronchodilator effect can mask airway inflammation and put pt at risk for sudden and life-threatening asthma exacerbations

Question 11

Side effects of β agonists?

Answer 11

Agitation, irritability, tremor, insomnia, tachycardia, arrhythmia

Hypokalemia, hyperglycemia in pts w/diabetes

Question 12

MOA for inhaled corticosteroids in treating asthma?

Answer 12

Decrease airway inflammation
Decrease bronchial hyperresponsiveness
Relieve asthma symptoms
Improve lung function

Question 13

MOA of leukotriene antagonists in treating asthma?

Answer 13

Block inflammatory pathways
Easy to administer orally
Montelukast most commonly used for pts <12 yo

Question 14

Warning signs of severe asthma exacerbation?

Answer 14

Lethargy, pallor or cyanosis, severe retractions, prolonged exhalation, inability to speak, poor air movement (w/lack of wheezing)

Question 15

How to initially treat children with symptoms of bronchospasm?

Answer 15

Cough, wheezing, chest tightness, retractions:
Treat with SABA, up to 2-3 treatments can be given back to back 20 min apart
If sx resolve, give as needed up to every 4 hours

Question 16

Which children are least likely to outgrow asthma?

Answer 16

Children with early-onset asthma (<3 yo) w/parental hx of asthma, dx of atopic dermatitis, or sensitization to aeroallergens (also depends on environment)