Pediatrics

Question 1

Risk Factors fo Pediatric Asthma

Answer 1

• Atopy
• Family hx of asthma
• Frequent respiratory infections
• In utero smoke exposure
• Exposure to passive smoke
• Growing up in low income, urban environment

Question 2

Diagnosis of Pediatric Asthma

Answer 2

• Symptoms
  
  • Frequency/Severity
  • Exacerbating Factors
  • Troublesome cough, worse at night
  • Awakened by coughing
  • Cough/wheeze after physical activity
  • Breathing problems during a particular season
  • Cough, wheeze, dyspnea after allergen exposure
  • Colds that last more than 10 days
  • Relief when asthma medication is used
• Med Frequency and Response
• Allergic Dzs
• Family Hx
• Social Hx
• Persistent Wheezers
  
  • Maternal asthma
  • Exposed to maternal smoking
    
    • Decreased airway growth in utero
    • Enhanced bronchial hyperresponsiveness
    • Diminished lung function
  • Elevated serum IgE
  • Eczema
  • Rhinitis

Question 3

Signs and Symptoms in Pediatric Asthma

Answer 3

• Early Signs
  
  • Cough, wheeze, dyspnea, tight chest
• Later Signs
  
  • Nasal flaring, retractions, cyanosis

Question 4

Asthma Triggers in Pediatrics

Answer 4

• Viral respiratory infections
• Pollution
• Pets
• Animals
• Pollen-tree, grass, weeds
• Mold
• Strong Odors
• Exercise
• Weather Changes
• Tobacco Smoke
• Stress/Anxiety/Emotions

Question 5

Allergy Testing for Pediatric Asthma

Answer 5

• Helps guide environmental control
• Skin Testing = GOLD STANDARD
  
  • RAST is alternative in some situations

Question 6

Stepwise Approach for Managing Asthma in Children 4 yo and Younger

Answer 6

• Step 1
  
  • SABA prn
• Step 2
  
  • Low-Dose ICS
  • Alternative
    
    • Cromolyn
    • Montelukast
• Step 3
  
  • Medium-Dose ICS
• Step 4
  
  • Medium-Dose ICS + Either LABA or Montelukast
• Step 5
  
  • High-Dose ICS + Either LABA or Montelukast
• Step 6
  
  • High-Dose ICS + Either LABA or Montelukast
  • Oral Systemic Corticosteroids

Question 7

Stepwise Approach for Managing Asthma in Children 5-11

Answer 7

• Step 1
  
  • SABA prn
• Step 2
  
  • Low-Dose ICS
  • Alternative
    
    • Cromolyn
    • LTRA
    • Nedocromil
    • Theophylline
• Step 3
  
  • Low-Dose ICS + LABA, LTRA, or Theophylline
  • OR
  • Medium-Dose ICS
• Step 4
  
  • Medium-Dose ICS + LABA
  • Alternative
    
    • Medium-Dose ICS + LTRA or Theophylline
• Step 5
  
  • High-Dose ICS + LABA
  • Alternative
    
    • High-Dose ICS + Either LTRA or Theophylline
• Step 6
  
  • High-Dose ICS + LABA + Oral Systemic Corticosteroid
  • Alternative
    
    • High-Dose ICS + LTRA or Theophylline + Oral Systemic Corticosteroid