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Peds Asthma Flashcards

1
Q

What is the purpose of a spacer with an albuterol inhaler?

A

Improves deposition in the airways

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2
Q

What is the use of a neb?

A

For younger kids less than 5 yo

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3
Q

What are the drugs that are used for asthma?

A

Beta agonist with ipratropium bromide

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4
Q

When are steroids indicated for asthma?

A

Exacerbations

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5
Q

What is the use of fluticasone?

A

Long term control of asthma

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6
Q

When is a CXR indicated for asthma exacerbation? What if this is normal?

A

If not better after 3 albuterol nebs.

Continue if normal

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7
Q

How many times should beta agonists/ipratropium be given prior to changing to something else? What should be done next?

A

x3, then switch to a continuous administration of beta agonist, and steroids

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8
Q

What happens to the lungs with chronic asthma?

A
  • Flattening of the diaphragm

- Hyperinflation of the lungs

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9
Q

In whom is asthma more common? (3)

A
  • Blacks
  • Hispanics
  • Inner city
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10
Q

What are the trends of asthma?

A

Increasing incidence

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11
Q

What indicated poor control of asthma?

A
  • 2 or more hospitalizations in the past year
  • more than 3 ED visits in the past year
  • More than 2 canisters/month
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12
Q

What are transient wheezers?

A

Pts who wheeze secondary to a LRTI prior to age 3, but then resolve

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13
Q

Who are nonatopic wheezers? What is the relation between these patients and RSV?

A

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

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14
Q

Who are atopic wheezers? What ab levels are elevated in this group? What are their lung functions like?

A

Pts with a family h/o asthma and are likely to have asthma

Elevated IgE
More profound lung function deficits

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15
Q

What percent of children’s asthma resolved by adulthood?

A

60%

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16
Q

What percent of asthmatic children convert to severe asthma in adulthood

A

30%

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17
Q

What are the ideas behind the hygiene hypothesis?

A

Absence of exposure increases Th2 responsiveness

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18
Q

How do you diagnose asthma? (3)

A
  • Recurrent episodes of airway hyperresponsiveness and obstruction
  • Partially reversible
  • Exclude other diagnoses
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19
Q

True or false: coughing may be the only symptom of asthma

A

True

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20
Q

What is the usual wheezing type with asthma? Is this always present?

A

Expiratory

Not always present

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21
Q

What are the two major meds that exacerbate asthma?

A

NSAIDs

Beta blockers

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22
Q

Why does ASA cause asthma exacerbation?

A

Shunts arachidonic acid to leukotrienes, which increases bronchoconstriction

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23
Q

What happens to the expiratory phase with asthma?

A

Prolonged

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24
Q

What is pulsus paradoxus?

A

an abnormally large decrease (10 mmHg) in systolic blood pressure and pulse wave amplitude during inspiration

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25
What causes the palpable liver and spleen with asthma?
Hyperinflation of the lungs
26
What is the obstructive pattern of spirometry (values)?
FEV1 less than 0.8 | FEV1/FVC less than 65%
27
How helpful are labs with asthma? What will these show?
Not at all. Elevated IgE Eosinophilia
28
What are the CXR findings with asthma? (4)
- hyperinflation - Peribronchial thickening - atelectasis - pneumothorax
29
What are the defining characteristics of a psychogenic cough?
- Will completely disappear at night | - Increased with attention to cough
30
What age group is most commonly affected with vocal cord dysfunction?
Adolescents
31
What is vocal cord dysfunction?
Paradoxical movement of the vocal cords during inspiration
32
What are the PFT findings of vocal cord dysfunction?
Flat inspiratory loop on PFTs, with no response to asthma meds
33
What are the four types of asthma?
- intermittent - mild persistent - moderate - severe persistent
34
At what point do you put kids on inhaled steroids?
More than mild persistent asthma
35
How do you categorize asthma severity? (4)
- Frequency/ssx - Frequency of beta 2 agonist use - Degree of interference with activity - PFTs
36
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
37
What are the characteristics of mild persistent asthma?
- 3-6 days/week - 1-2 night time - minor limitation
38
What is the treatment for mild persistent asthma?
low dose ICS
39
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
40
What are the prophylactic treatment for asthma? (3)
- Flu vaccine - smoking cessation - Treat comorbidities
41
True or false: all patients with persistent symptoms should be started on long term controller medications
True
42
Do antileukotrienes take the place of ICS?
No
43
How long does it take for ICS to take full effect?
4 weeks
44
Why do you need to rinse and spit after ICS use?
May develop thrush
45
What is the use of leukotriene modifiers?
Alternative treatment for mild, persistent asthma
46
Do LABAs work acutely?
No
47
What is the severe side effect of LABAs?
Sudden cardiac death
48
What are the side effects of SABAs?
- Tachycardia - Tremor - Irritability - Hypokalemia
49
When are anticholinergics used for asthma?
Used in the ED only
50
Are SABAs okay to be used scheduled daily?
No
51
What are the indications for systemic corticosteroids?
Moderate to severe asthma exacerbation
52
True or false: IV and PO corticosteroids are equally efficacious in treating asthma
True
53
How do you monitor asthma?
-PFTs
54
Wheezing before 3 years of age is associated with what?
LRTIs
55
Children with (__) or more episodes of wheezing/year are more likely to develop asthma?
More than 4
56
Major or minor risk factor for asthma: Parental h/o asthma
Major
57
Major or minor risk factor for asthma: h/o atopic dermatitis
Major
58
Major or minor risk factor for asthma: sensitization to foods
Minor
59
Major or minor risk factor for asthma: greater than 4 % eosinophils
Minor
60
Major or minor risk factor for asthma: Wheezing not associated with URIs
Minor
61
Major or minor risk factor for asthma: sensitization to aeroallergens
Major

Respiratory (34 decks)

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