Peds Asthma Flashcards
What is the purpose of a spacer with an albuterol inhaler?
Improves deposition in the airways
What is the use of a neb?
For younger kids less than 5 yo
What are the drugs that are used for asthma?
Beta agonist with ipratropium bromide
When are steroids indicated for asthma?
Exacerbations
What is the use of fluticasone?
Long term control of asthma
When is a CXR indicated for asthma exacerbation? What if this is normal?
If not better after 3 albuterol nebs.
Continue if normal
How many times should beta agonists/ipratropium be given prior to changing to something else? What should be done next?
x3, then switch to a continuous administration of beta agonist, and steroids
What happens to the lungs with chronic asthma?
- Flattening of the diaphragm
- Hyperinflation of the lungs
In whom is asthma more common? (3)
- Blacks
- Hispanics
- Inner city
What are the trends of asthma?
Increasing incidence
What indicated poor control of asthma?
- 2 or more hospitalizations in the past year
- more than 3 ED visits in the past year
- More than 2 canisters/month
What are transient wheezers?
Pts who wheeze secondary to a LRTI prior to age 3, but then resolve
Who are nonatopic wheezers? What is the relation between these patients and RSV?
Patients who have increased airway reactivity and continue to wheee after 3 years of age, but may resolve over time
Have an increased incidence of RSV
Who are atopic wheezers? What ab levels are elevated in this group? What are their lung functions like?
Pts with a family h/o asthma and are likely to have asthma
Elevated IgE
More profound lung function deficits
What percent of children’s asthma resolved by adulthood?
60%
What percent of asthmatic children convert to severe asthma in adulthood
30%
What are the ideas behind the hygiene hypothesis?
Absence of exposure increases Th2 responsiveness
How do you diagnose asthma? (3)
- Recurrent episodes of airway hyperresponsiveness and obstruction
- Partially reversible
- Exclude other diagnoses
True or false: coughing may be the only symptom of asthma
True
What is the usual wheezing type with asthma? Is this always present?
Expiratory
Not always present
What are the two major meds that exacerbate asthma?
NSAIDs
Beta blockers
Why does ASA cause asthma exacerbation?
Shunts arachidonic acid to leukotrienes, which increases bronchoconstriction
What happens to the expiratory phase with asthma?
Prolonged
What is pulsus paradoxus?
an abnormally large decrease (10 mmHg) in systolic blood pressure and pulse wave amplitude during inspiration
What causes the palpable liver and spleen with asthma?
Hyperinflation of the lungs
What is the obstructive pattern of spirometry (values)?
FEV1 less than 0.8
FEV1/FVC less than 65%
How helpful are labs with asthma? What will these show?
Not at all.
Elevated IgE
Eosinophilia
What are the CXR findings with asthma? (4)
- hyperinflation
- Peribronchial thickening
- atelectasis
- pneumothorax
What are the defining characteristics of a psychogenic cough?
- Will completely disappear at night
- Increased with attention to cough
What age group is most commonly affected with vocal cord dysfunction?
Adolescents
What is vocal cord dysfunction?
Paradoxical movement of the vocal cords during inspiration
What are the PFT findings of vocal cord dysfunction?
Flat inspiratory loop on PFTs, with no response to asthma meds
What are the four types of asthma?
- intermittent
- mild persistent
- moderate
- severe persistent
At what point do you put kids on inhaled steroids?
More than mild persistent asthma
How do you categorize asthma severity? (4)
- Frequency/ssx
- Frequency of beta 2 agonist use
- Degree of interference with activity
- PFTs
What are the characteristics of intermittent asthma, and is appropriate for PRN beta 2 agonist use? (days/week and nighttime ssx)
- Less than 2 days per week
- No nighttime ssx
What are the characteristics of mild persistent asthma?
- 3-6 days/week
- 1-2 night time
- minor limitation
What is the treatment for mild persistent asthma?
low dose ICS
What are the FEV1 and FEV1/FVC for intermittent asthma kids? MIld persistent
LFEV1 greater than 80 for both
FEV1/FVC greater than 85 for intermittent, greater than 80 for mild persistent
What are the prophylactic treatment for asthma? (3)
- Flu vaccine
- smoking cessation
- Treat comorbidities
True or false: all patients with persistent symptoms should be started on long term controller medications
True
Do antileukotrienes take the place of ICS?
No
How long does it take for ICS to take full effect?
4 weeks
Why do you need to rinse and spit after ICS use?
May develop thrush
What is the use of leukotriene modifiers?
Alternative treatment for mild, persistent asthma
Do LABAs work acutely?
No
What is the severe side effect of LABAs?
Sudden cardiac death
What are the side effects of SABAs?
- Tachycardia
- Tremor
- Irritability
- Hypokalemia
When are anticholinergics used for asthma?
Used in the ED only
Are SABAs okay to be used scheduled daily?
No
What are the indications for systemic corticosteroids?
Moderate to severe asthma exacerbation
True or false: IV and PO corticosteroids are equally efficacious in treating asthma
True
How do you monitor asthma?
-PFTs
Wheezing before 3 years of age is associated with what?
LRTIs
Children with (__) or more episodes of wheezing/year are more likely to develop asthma?
More than 4
Major or minor risk factor for asthma: Parental h/o asthma
Major
Major or minor risk factor for asthma: h/o atopic dermatitis
Major
Major or minor risk factor for asthma: sensitization to foods
Minor
Major or minor risk factor for asthma: greater than 4 % eosinophils
Minor
Major or minor risk factor for asthma: Wheezing not associated with URIs
Minor
Major or minor risk factor for asthma: sensitization to aeroallergens
Major
