Week 3.2 - Asthma Flashcards
For our lungs to work best, we need air that is…
Warm
–> body temp, 37°C
Damp
–> 100% humidity
Clean
–> Smoke, dust, pollen, bacteria free
Rapid abdominal breathing with retractions are indicative of what respiratory condition?
Asthma
What are the three changes seen in bronchioles in those with asthma?
- Chronic inflammation and airway edema
- Constriction of smooth muscles (bronchoconstriction)
- Secretions
+ results in airway remodeling
What things are assessed in the PRAM score?
Suprasternal Retractions
–> Absent (0)
–> Present (2)
Scalene Muscle Contraction
–> Absent (0)
–> Present (2)
Air Entry
–> Normal (0)
–> Decreased at bases (1)
–> Widespread Decrease (2)
–> Absent/minimal (3)
Wheezing
–> None (0)
–> Expiratory (1)
–> Ins + exp (2)
–> Audible w/o Stethoscope or Silent (3)
Oxygen Saturation on Room Air
–> >94% (0)
–> 92-94% (1)
–> <92% (or cannot be titrated from O2) (2)
How is scalene muscle contraction assessed?
Must be palpated
What is considered a mild, moderate, and severe PRAM score?
Mild
–> 0-3
Moderate
–> 4-7
Severe
–> 8-12
What is a PRAM score?
Pediatric Respiratory Assessment Measure
Why is it difficult to diagnose asthma in children under six?
It can be challenging to get young children to cooperate or perform pulmonary function tests.
At what age can pulmonary function tests be used?
6+
(generally)
How can asthma be diagnosed in children under 6?
If the child has two documented episodes of asthma likes symptoms in the last year and symptoms can be improved with Ventolin, we will diagnose and treat it like asthma until a pulmonary function test can be administered.
What are important parts of the comprehensive history of a child presenting with symptoms of asthma?
Family Hx
Eczema?
Pets?
Heating?
Carpets?
Exacerbations?
What are the three most common triggers for an asthma exacerbation?
- Viruses
- Physical activity
- Allergies
A child may only have exacerbations associated with one trigger
What are the two kinds of puffers used for asthma?
Controller
–> corticosteroid (red)
Reliever
–> B-blocker (blue)
How can corticosteroids affect a child’s height?
Potential loss of 1cm height seen in first year of use.
When are oral corticosteroids used for asthma? What one is used?
Prednisone (dexamethasone)
–> Emergencies only
What colour spacer is used for children of what age?
yellow w mask - 1-5
blue - 5+
What is a pediatric asthma action plan? What is meant by the green/yellow/red zones?
An action plan that guides and manages the child’s asthma based on a green, yellow and red zone.
green - healthy
–> maintenance everyday
Yellow - exposure to trigger –> cold or daytime symptoms more than 3 times a week
–> maintenance + reliever every 4 hours
Red - Respiratory distress + reliever lasts less than 3 hours
–> Take 4-6 puffs rescue every 15-20 minutes and call 911 or go directly to ER.
What condition might be able to explain coughing spells, night-time coughing, frequent colds, and a history of pneumonia?
Asthma
How does frequent use of oral corticosteroids or long-term use of inhaled corticosteroids affect the adrenal glands?
Leads to decreased cortisol production and a reduced ability to respond to stressors.
What is the strongest identifiable predisposing factor for developing asthma?
Atopy - a genetic predisposition for the development of an IgE-mediated response to aeroallergens
How does RSV affect asthma?
Exposure to RSV and other viral resp infections may play a significant role in the development and expression of asthma.
