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Peds Asthma
| Question | Answer |
|---|---|
| What is asthma? | airway inflammation, airway hyperreactivity, (reversible) airway obstruction |
| Sx of Asthma | wheezing, coughing, chest tightness or pain, shortness of breath |
| Assessing frequency of sx: | number of hospitalizations/ICU admissions, Number of ER or PMD visits, Missed days of school or work, Days/week with sx |
| Asthma Triggers | URI's, exercise, changes in weather, exposure to irritants, emotional states, allergens, cold air, seasons, medications, food additives |
| when taking an asthma hx, use the term | respiratory sx (as opposed to just saying asthma sx) |
| PE of Asthma pt | pulmonary, HEENT (polyps, postnasal drip), skin (eczema), extremities (if clubbing likely not asthma) |
| nasal polyps and clubbing suggest | Cystic Fibrosis |
| Differential Diagnosis of chronic asthma | anatomic abnormality, infection, Foreign body, cystic fibrosis, gastroesophgeal reflux, bronchopulmonary dysplasia, pulmonary edema, laryngeal dysfunction |
| Most common trigger for Asthma | Infection |
| Lab Studies include: Blood tests - CBC + differential immune work up QIGs, antibody titers, Sweat test (only at a CF center), Skin testing, GER evaluation, and | Pulmonary function - spirometry + lung volumnes, methacholine challenge exercise testing, CXR and sinus films, bronchoscopy |
| Skin testing | does not tell you what you are allergic to, but what you are sensitive to. Sensitivity must be tied to allergies |
| CXR indications | Atypical presentation, asymmetric breath sounds, suspicion of FB, lack of clinical improvement, worsening clinical course, persistent oxygen requirement |
| CXR findings | nl, hyperinflation, peribronchial thickening, atelectasis versus infiltrate, pneumothorax/pneumomediastinum |
| test to assist in asthma diagnosis | methacholine challenge |
| Tx for asthma | patient education, prevention/environmental control, pharmacotherapy, home monitoring |
| Ideal asthma management tx | daily anti-inflammatory agent plus PRN bronchodilator agent |
| Bronchodilators | methylaxanithine derivatives, beta-2 agonists, anti-cholinergics |
| Anti-inflammatory agents | mast cell stabilizers, steroids, leukotriene inhibitors, anti-IgE antibodies |
| Salmeterol (Serevent) note: | it is a Long acting Beta Agonist (LABA) and should not be used as monotherapy |
| Cromolyn (intal) and nedocromil (tilade) are | mast cell stabilizers |
| Beclomethasone, triamcinolone, flunisolide, fluticasone, budesonide are | inhaled steroids. Wiped out by liver in the first pass, so don't stay in the system long to have systemic effects |
| Advair | Fluticasone and Salmeterol |
| Symbicort | Budesonide and formoterol |
| Combination therapy indication | NAEPP Guidelines: part of first line therapy for moderate to severe persistent asthma |
| LABA black box warning (serevent) | sudden death, higher rates in AA |
| Systemic steroids are used to treat: | acute asthma attacks. Duration of therapy: mild to mod flare: 3-5 days with no taper required, moderate to severe flare: 5 days with taper as per clinical course |
| Topical side effects of inhaled steroids | oral thrush, change in phonation. Systemic side effects: dose dependent, uncommon if total daily dose is <1200mg of beclomethasone/day |
| Short term side effects of systemic steroids | increased appetite, weight gain, fluid retention, irritability |
| Long term side effects of systemic steroids | growth suppression, adrenal suppression, immunosuppression, decreased bone density, htn, DM, glaucoma, cataracts |
| Assessing canister fullness | count the amount of medication used; some meds have counters on them |
| why don't you use an inhaler "bone dry" | drug is likely gone and patient is getting more propellant |
| Peak flow meter uses: monitor daily pulmonary fxn, measure diurnal variation in pulmonary fxn, monitor degree of airway obstruction, predict asthma exacerations before symptomatic, and | monitor response to asthma therapy, provocational testing (trigger assessment), assess if sx are due to asthma |
| Peak flow meters should be used _____ | daily |
| Candidates for peak flow meters: all pts with severe asthma, select pts with moderate asthma, pts with poorly controlled asthma, and | pts unsure of their asthmatic triggers, pts who underestimate the degree of their illness and extent of their airway obstruction |
| Establishing peak flow zones | baselines values, personal best, percent predicted |
| >80% of peak flow | Green zone |
| 50-80% peak flow | yellow zone |
| <50% peak flow | red zone |
| Poor asthma control may suggest | not enough meds, confounding feature being missed (allergies, GER, CF), wrong diagnosis, Suboptimal medication delivery (poor technique (no spacer), poor adherence |
| When to refer for asthma | acute life-threatening asthma attack, mod to severe asthma, steroid dependent asthma, atypical/complicated asthma, poor response to optimal tx, confounding variables are present, more complicated dx studies required |
| In a well-controlled asthmatic, albuterol should last | 1 year. Don't do an auto refill |
| If pt has 2 or more exacerbations per week, they need an | inhaled steroid. |
| Patient education | make sure they understand the difference between inhaled steroid vs. albuterol (rescue medicine) |
Created by:
ltm12