Peds Asthma
Help!
|
|
||||
|---|---|---|---|---|---|
| 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)
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
ltm12