Chronic Respiratory- Peds Flashcards
atopic dermatitis (ezcema)
- Loss of function in the epidermal barrier
o Due to environmental exposures: climate, air pollution, water hardness and early exposure to nonpathogen microorganisms.
o Alteration of cutaneous microbiome
atopic dermatitis (eczema): risk factors
o Genetics: family hx of atopic dermatitis, asthma or allergic rhinitis.
atopic dermatitis: s/s
o In children/adults with deeply pigmented skin, erythema may appear dark brown or violaceous instead of pink/red, as typically seen in patients with less/lighter pigmentation in their skin.
o Typically appears on extensor surfaces in younger children, whereas it is the flexural surfaces in older children/adults.
o Dry skin
o Severe pruritis
chronc/subacute eczema
Dry, scaly, excoriated/erythematous papules
Skin thickening (lichenification) or fissures from scratching
acute eczema
Intensely pruritic, erythematous papules and vesicles with exudates/crusting
tx atopic dermatitis
o Showering/bathing daily: unscented dove bar soap to help remove any irritants/allergens on the skin
* Drip dry, do not rub dry with towel: friction on skin can be irritating
* While still moist, should apply topical steroids/creams and lotions, to help lock-in moisture
o Unscented lotions: Lubriderm, Cetaphil, Aveeno, Aquaphor
o Wet pajamas
o Daily antihistamines can help with underlying histamine response; combination of both long-acting and short-acting works best
o Swimming in a swimming pool vs. bleach baths
* 1 cup of baking soda/bleach for ½ tub full of water: soak in the bath for 10-15 minutes, then rinse well. (recommended daily for at least 3x/week
o Long-acting non-drowsy
* Loratidine
* Cetirizine
* Levocetirizine
* Fexofenadine
o Short-acting drowsy (Recommend nightly before bed)
* Diphenhydramine
* Hydroxyzine
o Topical steroids
* Group 1 is highest potency and group 7 is lowest. You want to start with the lowest potency and work your way up.
* Hydrocortisone 2.5% is most commonly prescribed but not great for the face. (lowest)
* Triamcinolone is okay to use on the face (step up from Hydrocortisone)
* Thins the skin so don’t want to be on it too long (2 weeks max)
allergic rhinitis (seasonal allergies): s/s
o Clear rhinorrhea
o Boggy nasal turbinates
o Sneezing
o Allergic salute– When patients rub their nose due to itching/running
o Allergic shiners– Dark circles under the eyes caused by congestion of nose/sinuses
* Treatment:
o Long-acting daily antihistamines
o Short-acting daily antihistamines
tx of allergic rhinits
o Daily short acting and long-acting antihistamines
o Nasal sprays
* Flonase: Fluticasone Furoate (27.5 mcg/spray)/Fluticasone Propionate (50mcg/spray): intranasal steroid
* Start with 1 spray in each nostril twice daily to manage symptoms; once controlled:
o Can drop to 1-2 sprays in each nostril daily
* Mometasone
* Children under 12: 1 spray in each nostril daily
* Children over 12: 1 spray in each nostril twice daily
* Cromolyn (sodium cromoglycate)
* Not absorbed systemically; good choice for parents concerned about potential side effects of other medications, who are willing to administer something regularly.
* Nasal saline
* Follow instructions on the box; no limit to how many times per day to be used.
asthma
- A condition where airways become inflamed, narrow and swell and produce extra mucus, making it difficult to breath: due to a trigger
asthma: s/s
difficulty breathing, chest pain, cough and wheezing
asthma: triggers
environmental, food, climate, exposure to second-hand smoke
classifying asthma
o Step 1: Mild Intermittent
* Symptoms fewer than twice/week
* No issues between flares (flares are short: a few hours-a few days)
* Nighttime symptoms: less than twice/month
o Step 2: Mild Persistent Asthma
* Symptoms 2+ times/week, but no more than once daily
* Activity levels may be affected by flares
* Nighttime symptoms: 2+/month
o Step 3: Moderate Persistent Asthma
* Symptoms daily
* Uses rescue (SABA) daily
* Has flares 2+ times/week
* Activity levels may be affected by flares
* Nighttime symptoms 1+/week
o Step 4: Severe Persistent Asthma
* Constant symptoms
* Decrease in physical activity
* Frequent flares
* Nighttime symptoms frequently
how to use a peak flow meter
- 1: place the marker at the bottom of the scale
- 2: stand up/sit up straight
- Take a deep breath
- Put the meter in the mouth and close lips around mouthpiece. Do not put tongue inside the hole. Do not cover the hole on the back end of the PFM when holding it
- 5: Blow out as hard/fast as possible. Don’t cough/huff into the PFM, as this will give a false reading.
- 6: write down the number from the meter
- 7: Repeat steps 1-6 two more times
- 8: Write the highest of the 3 numbers in your child’s peak flow diary every day/as instructed
how to measure spirometry
- FEV: forced expiratory volume (how much you can exhale during a forced breath)
- FVC: forced vital capacity (total amount of air you can exhale forcefully in one breath)
- FEV1: amount of air you can force from your lungs (exhale) in one second.
o Greater than 80% of predicted= normal
o 65%-79% of predicted= mild obstruction
o 50%-64% of predicted= moderate obstruction
o Less than 50% predicted= severe obstruction
Why not treat with SABA alone in 12+
- Inhaled SABA baseline treatment for asthma for the past 50 years:
o Asthma was thought to be a disease of bronchoconstriction
o Role of SABA reinforced by rapid relief of symptoms and low cost - Use of SABA is still necessary for those with breakthrough symptoms on a daily ICS (SABA=rescue med; ICS=maintenance)
- Regular use of SABA, even for 1–2 weeks, is associated with increased AHR, reduced bronchodilator effect, increased allergic response, increased eosinophils
o Can lead to vicious overuse cycle
o SABA use only lead to increased exacerbations and mortality
