Respirology Flashcards
Surveillance of CF patients
False Positive Sweat Chloride
- adrenal insufficiency or stress
- Anorexia
- ectodermal dysplasia
- eczema
- fucosidosis
- G6PD
- GSD Type 1
- HIV
- hypoparathyroidism
- hypothyroidism
- malnutrition
- nephrogenic DI
- pseudohypoaldosteronism
- chronic arsenic exposure
Clinical features of CF
I - infertility
M - meconium ileus
C - cough
F - FTT
P - pancreatic insufficiency
A - asthma (refractory)
N - nasal polyps
C - clubbing
R - rectal prolapse
E - electrolytes (low Na/K/Cl, metabolic alkalosis)
A - atypical bugs in sputum
S - sludge/sinusitis
Diagnosis of CF
- clinical history OR positive sibling OR positive NBS
AND - 2x high sweat chloride OR positive nasal potential difference OR 2x gene mutations
Prognostic factors in CF
- male > female
- FEV1
- Burkholderia cepacia
- pneumothorax
- nutrition (height/weight, CFRD)
Risk factors for fatal or near-fatal asthma
- any previous near-fatal asthma exacerbations (ie. previous ICU admissions, ventilation, respiratory acidosis)
- recurrent hospitalizations or ED visits in the last year
- severe asthma
- overuse of SABA
- poor adherence to treatment plans
- failure to attend clinic appointments
- depression, anxiety or other psych illness
- alcohol or other substance use
- obesity
- severe domestic, marital, employment, local stress
- denial of illness or severity of illness
Risk factors for severe asthma exacerbation
- any history of a previous severe asthma exacerbation (requiring any of the following: systemic steroids, ED visit or hospitalization).
- poorly controlled asthma per CTS criteria
- overuse of SABA (defined of use of more than 2 inhalers of SABA in a year)
- current smoker
Asthma control criteria
- Daytime symptoms </= 2 times/week
- Nighttime symptoms < 1 night/week
- Physical activity normal
- Mild, infrequent exacerbations
- No absence from school
- SABA </= 2 times/week
- FEV1 or PEF >/= 90% of best
Diagnosis of asthma in pre-schoolers?
- documented wheeze/obstruction by HCP + improvement with SABA/ICS
- caregiver report of obstruction + response to 3 month trial of ICS/SABA
Diagnosis of asthma in school age children?
- FEV1/FVC < 0.8-0.9 + FEV1 increased by >/= 12 % with bronchodilator
- PEF increase by >/= 20% with SABA or course of controller
- methacholine challenge (<4mg/ml or < 0.5umol
- exercise decreases FEV1 >/= 10-15%
Reasons to refer to an asthma specialist
- diagnostic uncertainty
- kids not controlled on moderate dose ICS with correct inhaler technique and appropriate medication adherence
- suspected or confirmed severe asthma
- life-threatening event such as an admission to ICU for asthma
- need for allergy testing to assess the possible role of environmental allergens in those with a suggestive clinical history
- confirmed or suspected work-related asthma
- any asthma hospitalization (all ages), >/= 2 ED visits (all ages) or >/= 2 courses of systemic steroids (kids).
***asthma specialist includes specialists in asthma, general resp, pediatrics, allergy/immunology who have access to lung function, educators etc
Syndromes associated with choanal atresia
- CHARGE syndrome
- Treacher-Collins
- Kallman syndrome (most common form of congenital hypogonadotropic hypogonadism)
- VATER association (vertebral defects, imperforate anus, TEF, renal defects)
- Pfeiffer syndrome
Where does the blood come from in CF hemoptysis?
Bronchial arteries –> airway bleeding! Can exsanguinate!
Criteria for PCD
- neonatal respiratory distress
- year round productive cough
- year round nasal congestion
- laterality defects
Indications for RSV prophylaxis
- children with hemodynamically significant CHD or CLD (defined as a need for O2 at 36 weeks GA) who require ongoing diuretics, bronchodilators, steroids or supplemental O2 should receive palivizumab IF they are <12 months at the start of RSV season. (2nd year of life only if still on or weaned off of supplemental oxygen in the past 3 months.)
- preterm infants WITHOUT CLD, born before 30 +0 weeks’ GA who are <6 mo of age at the start of RSV season (reasonable)
- infants in remote communities who would require air transport for hospitalization and born before 36+0 weeks GA and <6 mo at the start of RSV session should be offered palivizumab.
- Consideration may be given to administering palivizumab during RSV season to term Inuit infants until they reach six months of age only if they live in communities with documented persistent high rates of RSV hospitalization.
