Pedi Asthma Flashcards
(32 cards)
2007 guidelines from NHLBI focus on what 4 components for asthma mgmt?
- Measures to assess and monitor asthma
- Patient education
- Control of environmental factors and comorbid conditions affecting asthma
- Pharmacologic therapy
Dx of asthma depends on what factors?
- Episodic symptoms of airflow obstruction or airway hyperresponsiveness are present (medical hx, PE)
- Airflow obstruction is at least partially reversible (spirometry)
- Alternative diagnoses are excluded
Risk factors for asthma
- Family history of allergy, eczema, and asthma
- Smoking in the home
- Allergens including dust mites, pollen, pets
- Premature birth
Hx questions that can help aid in dx of asthma
- cough, wheeze (a whistling sound when breathing), have chest tightness or shortness of breath?
- colds go right to your child’s chest and last much longer than other siblings
- cough or wheeze with exercise, play, and laughter or during temper tantrums?
- FH of asthma or allergies?
- Triggers-colds; allergens (like the family pet), or exercise
- How often are the symptoms present and how bad?
- Is your child missing school?
- coughing or wheezing keeping you and your child up at night
Who is spirometry recommended for and what is its purpose?
Recommended for children 5 yrs. and older
Demonstrates obstruction and if it is reversible
Additional testing that may be considered in Dxing asthma?
- Chest x-ray
- Allergy testing
- Barium shallow
- Sinus films
- Bronchoscopy
- Bronchoprovocation
DDx asthma
- Allergic Rhinitis
- Sinusitis
- Bronchiolitis
- Foreign body aspiration
- Vocal cord dysfunction
- Vascular rings
- Laryngotracheomalacia
- Tumor or enlarged lymph nodes
- Tracheal stenosis
- BPD
- CF
- Congenital Heart Disease
- CHF
- Aspiration
- PE
- GERD
Barriers to Effective Asthma Care
- Under classification
- Difficult to interpret appropriate treatment
- Patient compliance
- Cost
- Assess to care
- Environmental controls
Goals of Asthma Therapy
- Prevent chronic symptoms and exacerbations
- Minimize use of short-acting bronchodilators
- Maintaining normal lung function
- Maintain normal activity
- Patient and family satisfaction with therapy
- Minimize side effects with therapy
Day to day effects of asthma nad risk for frequent exacerbations
some patients can still be at high risk for frequent exacerbations even if they have few day-to-day effects of asthma.
what age groups does stepwise asthma mgmt specify for?
- 0-4 years
- 5-11 years
- 12 years and older
What do patients with persistent asthma need, in terms of Tx?
- both: long-term control medications and quick relief medications for symptoms
- Inhaled corticosteroids are the preferred method of treatment with persistent asthma
What is the Asthma Control Test (ACT)?
- Self rating questionnaire for the parents to assess asthma control
- Assess daily activities, shortness of breath, SABA use and nightly symptoms
Management of Exacerbations
- Inhaled beta2-agonist x3 in office
- Systemic corticosteroids - 2 mg/kg/d not to exceed 60 mg/day
- O2 and hospitalization if needed
Short acting B2 agonists + anticholinergics: dosing and formulations
Short Acting Beta2-Agonist
- Albuterol 90mcg/actuation MDI 2 puffs with spacer or Albuterol nebulized solution (.083%) or 2.5mg (.5cc) with 3cc NS
- Levalbuterol (Xopenex®) 45 mcg/puff MDI 1-2 puffs or Nebulized solution: 0.025 mg/kg minimum 0.31 mg/3 ml unit dose; 0.63 mg/3 ml unit dose; 1.25 mg/3 ml unit dose
in combination with
Anticholinergics
- Ipratropium (Atrovent®) nebulized solution 0.25mg/ml 0.25-0.5 mg
Characteristics of mild exacerbation, cared for at home, SABA prn
possible short course PO steroids
dyspnea only w/activity (tachypnea in young kids)
PEF >70% predicted or personal best
Characteristics of Moderate Exacerbation that requires office or ED visit, frequent SABA; need PO steroids w/sxs lasting 1-2 days beyond tx
dyspnea interferes w/or limits usual activity
PEF 40-60% predicted or personal best
Characteristics of severe exacerbation w/ED visit and likely hospitalization, partial relief from frequent saba, need PO steroids w/sxs lasting >3 days after tx begins, and adjunctive txs
dyspnea at rest, interferes w/conversation
PEF <40% predicted or personal best
Characteristics of life-threatening exacerbations w/required ED/hospitalization or ICU, minimal to no reief from inhaled SABA; need IV CSs, adjunctive Txs
Too dyspneic to speak, perspiring, PEF <25% predicted or personal best
Risk Factors for Death from Asthma
- Past history of severe exacerbations
- Prior Intensive Care Unit admission for asthma
- Prior Intubations from asthma
- Two or more hospitalization in the past year
- Three or more emergency department visits for asthma in the past year
- Hospitalization or ED visit in the last month
- Increase use of inhaled short- acing beta2 agonist
- Current or recent use of systemic corticosteroids
- Difficulty understanding severity of disease
- Comorbidity of cardiac or chronic respiratory disease
- Psychosocial issues, low socioeconomics, or urban living
- Psychiatric issues
- Illicit drug use
Adapted from NHLBI 2007
Exercise Induced Asthma: Dx
Exercise induced asthma is diagnosed when a history of coughing, shortness of breath, chest pain, or wheezing occurs during or after exercise. A definitive diagnosis is through spirometry or a decrease of 15% in peak flow with exertion
Exercise Induced Asthma: Tx
2-4 puffs short-acting beta2-agonist 5-60 minutes before exercise
or
Cromolyn or nedocromil before exercise
50% of patients respond to Leukotriene modifiers
How to avoid animal allergen triggers
- Remove the animal and products made of feathers from home
- Keep pets out of patient’s bedrooms
- Keep bedroom door closed
- Provide filtering materials over forced air vents to collect dust and dander
- Wash pets weekly to reduce dander
Cockroach control: how to control / avoid as triggers
Avoid leaving food or garbage exposed
Cockroach reduction with poison baits, traps or boric acid
