Peds respiratory issues

Question 1

Asthma impairment– Ages 0-4
Symptoms less than or equal to 2 days/week
no nighttime awakenings
short-acting (SABA) is only used less than 2 days /week
No interference with normal activity
Exacerbations requiring oral systemic corticosteroids 0-1/ year

Answer 1

Asthma Class–Intermittent

Question 2

Asthma impairment– Ages 5-11
Symptoms less than or equal to 2 days/week
nighttime awakenings less than 2 days /month
No interference with normal activity
Normal FEV1 (peak flow) between exacerbations >80%
FEV1/FVC > 85%
Exacerbations requiring oral systemic corticosteroids 0-1/ year

Answer 2

Asthma Class–Intermittent

Question 3

Asthma impairment– Ages 0-4
Symptoms greater than to 2 days/week but not daily
nighttime awakenings 1-2 times /month
short-acting (SABA) is used more than 2 days/week but not daily
Minor limitation to normal activity
Exacerbations requiring oral systemic corticosteroids more than 2 in 6 months. More than 4 wheezing episodes/ 1 year lasting more than 1 day and risk factors for persistent asthma

Answer 3

Asthma Class– Mild persistent

Question 4

Asthma impairment– Ages 5-11
Symptoms more than to 2 days/week but not daily
nighttime awakenings 3-4 times /month
short-acting (SABA) is used more than 2 days/week but not daily
Minor limitation to normal activity
Exacerbations requiring oral systemic corticosteroids more than 2/ year.

Answer 4

Asthma Class–mild persistent

Question 5

Asthma impairment– Ages 0-4
Daily symptoms
nighttime awakenings 3-4 times per month
SABA used daily
Some limitation with normal activity

Answer 5

Asthma Class–Moderate persistent

Question 6

Asthma impairment– Ages 5-11
Daily symptoms
nighttime awakenings 1 x per week but not nightly
SABA used daily
Some limitation with normal activity

Answer 6

Asthma Class–Moderate persistent

Question 7

Asthma impairment– Ages 0-4
Throughout the day
nighttime awakenings more than 1x per week
SABA several times per day
Extremely limited activity

Answer 7

Asthma Class–Persistent severe

Question 8

Asthma impairment– Ages 5-11
Throughout the day
nighttime awakenings often 7x per week
SABA several times per day
Extremely limited activity

Answer 8

Asthma Class–Persistent severe

Question 9

Recommended step initiating therapy to for intermittent class

Answer 9

step 1 for all ages SABA PRN

Question 10

Recommended step initiating therapy to for mild persistent class

Answer 10

Step 2–Add low-dose ICS
the alternative–cromolyn or montelukast
Consider subcutaneous allergen immunotherapy for patients who have persistent, allergic asthma
SABA as needed for symptoms.

Question 11

Recommended step initiating therapy to for moderate persistent class Ages 0-4

Answer 11

Step 3-Medium dose ICS
and consider a short course of oral systemic corticosteroids
SABA as needed for symptoms.

Question 12

Recommended step initiating therapy to for severe persistent class Ages 0-4

Answer 12

Step 3-Medium dose ICS
and consider a short course of oral systemic corticosteroids
SABA as needed for symptoms.

Question 13

Recommended step initiating therapy to for moderate persistent class Ages 5-11

Answer 13

Step 3-Medium dose ICS
and consider a short course of oral systemic corticosteroids
SABA as needed for symptoms.

Question 14

Recommended step initiating therapy to for severe persistent class Ages 5-11

Answer 14

Step 3-Medium dose ICS or Step 4- Add LABA or montekulast to ICS
and consider a short course of oral systemic corticosteroids
SABA as needed for symptoms.

Question 15

If Asthma is well controlled with all ages, which are symptoms less than 2 days/ week, no more than once a day.
1 x per month of nighttime awakening
no interference with activity
SABA is only used less than 2x/week

Answer 15

It is well controlled–maintain the current step
regular followup every 1-6 months
consider step down if well controlled for at least 3 months.

Question 16

In children ages 0–4 years with
recurrent wheezing triggered
by respiratory tract infections
and no wheezing between
infections, the Expert Panel
conditionally recommends

Answer 16

starting a short course of daily ICS at the onset of a respiratory tract infection with as-needed SABA for quick relief therapy compared to as-needed SABA for quick relief therapy ONLY

Question 17

In children 5-11 years with mild to moderate to severe asthma already taking a low or medium dose ICS what is the preferred treatment

Answer 17

Single inhaler with ICS-formoterol (referred to as SMART single maintenance and reliever therapy) used as daily controller and reliever therapy compared to either a higher dose ICS as daily controller and SABA for quick relief

Question 18

Flu clinical manifestation

Answer 18

It is difficult in younger children to distinguish
clinically influenza infection from infections due to other
respiratory viruses (eg, respiratory syncytial virus and PIV)
that circulate in communities during the same periods, and
the manifestations of disease can be identical. Upper respiratory tract infection (URI), laryngotracheitis (croup), bronchiolitis, and pneumonia are all
possible presentations of influenza in the younger child.
Gastrointestinal symptoms are uncommon in adults but
can be the primary symptoms in children with influenza.

Question 19

stridor

Answer 19

is a harsh, coarse, grating respiratory sound with crowing quality, often
audible without a stethoscope. Usually indicative of extrathoracic airflow obstruction, it represents the rapid, turbulent flow of air through a narrowed airway

Question 20

Stridor can originate from

Answer 20

any of the different areas of the airway, which can be
divided into 3 zones: (1) the supraglottic zone, which includes the pharynx; (2) the
extrathoracic tracheal zone, which includes the glottis, subglottic area, and
proximal trachea; and (3) the intrathoracic tracheal zone, which can extend to
the primary and secondary bronchi.

Question 21

causes of acute stridor

Answer 21

epiglottitis –Most commonly caused by Haemophilus influenzae type B; occurs in children 2 to 7 years of
age, peak incidence at 3 years of age; incidence reduced markedly by the use of the
H influenzae type B vaccine

Question 22

Most common cause of stridor

Answer 22

Although most often a mild and selflimited illness, croup has kept many a parent awake all night
(me included) fearfully watching a stridulous child in distress with a barking cough and labored breathing