Week 3.2 - Asthma

Question 1

For our lungs to work best, we need air that is…

Answer 1

Warm
–> body temp, 37°C

Damp
–> 100% humidity

Clean
–> Smoke, dust, pollen, bacteria free

Question 2

Rapid abdominal breathing with retractions are indicative of what respiratory condition?

Answer 2

Asthma

Question 3

What are the three changes seen in bronchioles in those with asthma?

Answer 3

1. Chronic inflammation and airway edema
2. Constriction of smooth muscles (bronchoconstriction)
3. Secretions

+ results in airway remodeling

Question 4

What things are assessed in the PRAM score?

Answer 4

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)

Question 5

How is scalene muscle contraction assessed?

Answer 5

Must be palpated

Question 6

What is considered a mild, moderate, and severe PRAM score?

Answer 6

Mild
–> 0-3

Moderate
–> 4-7

Severe
–> 8-12

Question 7

What is a PRAM score?

Answer 7

Pediatric Respiratory Assessment Measure

Question 8

Why is it difficult to diagnose asthma in children under six?

Answer 8

It can be challenging to get young children to cooperate or perform pulmonary function tests.

Question 9

At what age can pulmonary function tests be used?

Answer 9

6+
(generally)

Question 10

How can asthma be diagnosed in children under 6?

Answer 10

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.

Question 11

What are important parts of the comprehensive history of a child presenting with symptoms of asthma?

Answer 11

Family Hx
Eczema?
Pets?
Heating?
Carpets?
Exacerbations?

Question 12

What are the three most common triggers for an asthma exacerbation?

Answer 12

1. Viruses
2. Physical activity
3. Allergies

A child may only have exacerbations associated with one trigger

Question 13

What are the two kinds of puffers used for asthma?

Answer 13

Controller
–> corticosteroid (red)

Reliever
–> B-blocker (blue)

Question 14

How can corticosteroids affect a child’s height?

Answer 14

Potential loss of 1cm height seen in first year of use.

Question 15

When are oral corticosteroids used for asthma? What one is used?

Answer 15

Prednisone (dexamethasone)
–> Emergencies only

Question 16

What colour spacer is used for children of what age?

Answer 16

yellow w mask - 1-5
blue - 5+

Question 17

What is a pediatric asthma action plan? What is meant by the green/yellow/red zones?

Answer 17

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.

Question 18

What condition might be able to explain coughing spells, night-time coughing, frequent colds, and a history of pneumonia?

Answer 18

Asthma

Question 19

How does frequent use of oral corticosteroids or long-term use of inhaled corticosteroids affect the adrenal glands?

Answer 19

Leads to decreased cortisol production and a reduced ability to respond to stressors.

Question 20

What is the strongest identifiable predisposing factor for developing asthma?

Answer 20

Atopy - a genetic predisposition for the development of an IgE-mediated response to aeroallergens

Question 21

How does RSV affect ashtma?

Answer 21

Exposure to RSV and other viral resp infections may play a significant role in the development and expression of asthma.