peds resp. Flashcards
def. asthma
inflammatory disorder of the airway char by paroxysmal or persistnet Sx associated with variable degree of airflow limitations and responsiveness of the airway to stim.
Sx suggestive of athsma
- freq. breathlessness, wheeze or cough
- Sx worse at night or in early AM
- dev with infection, excercise, exposure to allergens
- after playing or laughing
- better with roids or dilators
2 requirements for asthma diagnosis
- FEV1/FVC 12% with dilators (in adults must be over 200ml)
how to diagnose in preschoolers
- not able to do PFTs
- need careful Hx and PHx
what is in asthma predictive index
>4 wheezing episodes in past year PLUS ONE major crit.: - parent with astma - atopic dermatitis - allergen sens OR 2 minor crti.: -food sens - peripheral eosinophilia - wheezing not related to infection
what is goal of asthma Sx management
want them to be asymtomatic
what are two main therapeutic targets
- smooth muscle dysfunction
2. airway inflammation
2 main types of meds and their types
- controllers
- roids
- LTRA
- amalizumab - relievers
- SABA
- LABA
what are guidelines for controller therapy
- regular controller therapy indicated for those with poor asthma control
- ICS are first line for all ages
- second line is LTRA
if taking low dose ICA, what are three options to increase
- increase to mod or high dose
- add LABA
- add LTRA
- not enough evidecne for
what is reccomendation for adults with low dose ICS for escalation
add a LABA
what is reccomendations for children on low dose ICS
mod or high dose
what is recc for children on mod-high dose ICS
add a LABA
what is CF
- auto recc. disorder
- affects lung, panc, intestines, liver
- affects CF transmembrae regulator
what is CFTR needed for
allows Cl out to keep a good layer of airway surface fluid
what are 6 classes of CF
- no protein
- poor folding- not on surface
- gets to surface, doesn’t work
- doesn’t work well
- not very many
- less stable
what are 2 types of CF and what classes in each
- panc. insuff
- !,2,3 - panc suff
4,5,6
3 things that influence CF outcomes
- genes
- env.
- time
what is needed for CF diagnosis
clinical features compatible OR CF in sib OR +ve newborn screeen PLUS lab evidence - sweat test - nasal PD - 2 disease causing mutations
what is levels for sweat test
sweat Cl > 60 is pos
30-60 intermediate
panc. insuff. have lower mean sweats
what are newborn screening steps
- check for trypsinogen on blood spot
- if elevated, check for 35 DNA mutations
- is mutations found - sweat test
Tx of pulm. manifestations for CF
- chest physio
- mucolytics
- ABs
- SABA
- ICS
- O2
- lung transplant
Tx of extra-pulm manifestations
- enzyme replacement
- ADEK vits
- high cal, high fat diet
- ursodiol
def. Obst. Sleep Apnea
recurrent events of full or partial complete upper airway obst. during sleep
what defines severe OSA
apnea-hyponea index >100/hour
2 general issues that make the balance
- neuromuscular activation
2. structural narrowing
2 ways to diagnose
- Hx and Phx - poor accuracy
2. polysomnogram
Tx for OSA
adenotonsillectomy
- cures 80%
