Clinical Medicine
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| Differential of cough and wheezing in children? | CRADLE
(Cystic Fibrosis, Respiratory tract infection, Aspiration, Dyskinetic cilia, Lung and airway malformations, Edema)
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| REVERSIBLE obstruction of airflow due to bronchial hyperreactivity, and inflammation of airway? | asthma
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| Risk factors for exacerbation: #1 ATOPY, URI, exercise induced, GERD, drugs (ASA), weather changes? | asthma
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| Symptoms: wheeze, prolonged expiration, dyspnea, cough? | asthma
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| Asthma Severity Classifications? 12 or older Symptoms day <2/wk, night <2/month; FEV1 > 80% predicted | mild intermittent
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| Asthma Severity Classifications? 12 or older Symptoms day >2/wk but NOT daily, night >2/month; FEV1 > 80% predicted | mild persistent
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| Asthma Severity Classifications? 12 or older Daily symptoms, night > 1/month; FEV1 60-80% predicted | moderate persistent
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| Asthma Severity Classifications? 12 or older Cont. daily symptoms w/ limited activity, night frequent, FEV1 < 60% | severe persistent
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| Ddx of? COPD, CHF, PE, Mechanical obstruction (tumor), Pulmonary infiltrate w/ eosinophilia, ACEI cough, vocal cord dysfunction | asthma
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| Pathophysiolgy inculdes? smooth muscle dysfunction airway inflammation airway remodeling | asthma
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| Triggers? exercise, URI, smoke, pollen, weather, animal fur or feathers, GERD | asthma
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| Management of acute mild exacerbation: asthma? | SABA
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| Management of acute moderate exacerbation: asthma? | SABA (q 60 min for 1-3 hours)
Oral steroids
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| Management of acute severe exacerbation: asthma? | SABA (high dose q 20 min)
Ipatropium (q 60 min)
Systemic steroids (po or IV)
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| Acute ____ exacerbation? dyspnea only with activity; PEF ≥ 70% pred or best | mild
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| Acute _____ exacerbation? dyspnea interferes with normal activity; FEV1 or PEF 40 - 69% pred/personal best | moderate
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| Acute _____ exacerbation? dyspnea at rest, interferes with conversation; FEV1 or PEF < 40% pred/personal best | severe
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| Complications of acute asthma exacerbation? | respiratory failure
pneumothorax
death
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| Long term goals of asthma therapy? | reduce impairment
reduce risk
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| 4 components of asthma care? | Assessment and monitoring
Control (environmental factors and comorbid conditions)
Medications
Education
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| Asthma *Control* Classification? symptoms <2 day/wk, <2night/month, FEV1 >80%, Rescue meds < 2days/wk | well controlled
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| Asthma *Control* Classification? symptoms >2 day/wk, >2night/wk, but not nightly, FEV1 >60 - <80%, Rescue meds >2days/wk | not well controlled
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| Asthma *Control* Classification? symptoms throughout the day, >4night/week, FEV1 <60%, Rescue meds several times per day | very poorly controlled
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