Thoracic Society

Question 1

True or False: You SHOULD use terms bronchospasm, reactive airway disease, wheezing bronchitis, happy wheezer.

Answer 1

False

Question 2

Typical min. PFT age

Answer 2

6

Usually due to cooperation required

Question 3

List diagnostic criteria for asthma in kids 1-5 y.o.

Answer 3

Recurrent (min. 2) asthma like symp (even if exacerbated by viruses only):

1. Doc Airflow Obstruction
   - wheezing or parental report
2. Reversibility
   - doc improvement w/ SABA or steroids via HCP, or parental report of better symptoms after 3h x ICS
3. No other alternative dx

Question 4

T or F: PMHX or FHX of atopy (eczema, food allergy) needed for Toddler Asthma Dx.

Answer 4

FALSE

Question 5

What are Red Flags it ISN’T ASTHMA

Answer 5

• wheeze in child < 1 y.o.
• stridor
• chronic wet cough, FTT, recurrent pneumonia (CF)
• paroxysms of cough
• prem w/ ++ O2 or vent (think BPD)
• focal sign on CXR

Question 6

What is the Tx IF Current signs reversible airflow obstruction + min. 1 other episode + no other red flag

Answer 6

Tx: SABA +/- PO steroids

if mod-severe exacerbation

Question 7

What is the Tx IF NO CURRENT signs and does not meet criteria?

Answer 7

1. Monitor

+/- 3 month therapeutic trial SABA PRN
+/- medium dose ICS (i.e. flovent 100 mcg BID) x 3 month if frequent symptoms (2d/week or 8d/month) or 1 pvx episode mod-severe exacerbation hx

Question 8

PRAM Criteria

Answer 8

1. O2 sat
   min. 95%= 0
   92-45= 1
   <92%= 2
2. Suprasternal retraction
   Absent= 0
   Present= 2
3. Scalene muscle contraction
   Absent= 0
   Present=2

4. AE
Normal= 0
Down at base= 1
Down at apex + base= 2
Minimal or absent= 3

5. Wheezing
Absent = 0
Exp= 1
Insp = 2
Audible without steth =3

Question 9

Pram Score: Mild, Mod, Severe

Answer 9

Mild 0-3
Mod 4-7
Severe 8+

Question 10

What do you give:

• min. 2 episodes asthma-like
• no wheeze
• frequent/severe

Answer 10

3 mo. ICS

SABA PRN

Question 11

What do you give:

• min. 2 epi. asthma
• no wheeze
• infrequent

Answer 11

R/A when symptomatic

OR trial PRN SABA

Question 12

what counts as frequent symptoms

Answer 12

8d/month or 2d/week

Question 13

General approach to asthma management

Answer 13

1. Non-pharm education, spacer instructions, avoid irritant (e.g. smoke)
2. Pharmacological
   - remember if med dose ICS effective then titrate to lowest dose possible
3. Monitoring
   - R/A 3-4 months

Question 14

T or F: Never trial off low dose ICS in preschoolers.

Answer 14

False.

• You should trial off when symptoms minimal on low-dose (flovent 50 mcg BID or 100 mcg daily) symptoms.

Question 15

When should you refer

Answer 15

• dx uncertainty
• min. 2 exacerbations needed oral steroids or hospitalization
• life-threatening event
• need for allergy testing