Pediatric Asthma Flashcards Preview

Respiratory 1 > Pediatric Asthma > Flashcards

Flashcards in Pediatric Asthma Deck (37):
1

asthma is-

-a disease of DIFFUSE, CHRONIC airway inflammation = acute exacerbation
-characterized by *hyperresponsiveness* and *airway obstruction*
-partially reversible
-intermittent, recurrent symptoms

2

transient wheezers:

-associated with LRTI
-no wheezing after age 3yr
-inc incidence of RSV infections
-"nonatopic" wheezers
-inc airway reactivity

3

Atopic wheezers

most likely to dev persistent asthma
-elevated IgE levels - prone to allergen mediated airway hyperresponsiveness
-more profound lung function deficits

4

Pathophys of asthma:

1) bronchoconstriction
2) edema
3) inc mucus production
4) airway remodeling (chronic)

5

diagnosis of asthma:

-recurrent episodes of airway obstruction or hyperresponsiveness
-at least partially reversible
-exclude alternate diagnoses

6

clinical symptoms:

1) cough
-gets worse at night
-usually only symptom
2) wheezing
-high-pitched whistling sounds on expiration
3) SOB
4) chest tightness
5) abdominal pain
6) vomiting
7) onset depends on triggers=acute or gradual

7

History to ask for asthma?

-pattern of symptoms?
-triggers/factors?
-Hx of recurrent wheezing/coughing?

8

Spirometry tsting:

-only useful/reliable in children 5 yr +
-FEV112%)

9

Lab for asthma?

not very useful
-Suggestive: eosinophilia; elevated serum IgE

10

Chest X-ray why?

Get baseline!

11

Vocal cord dysfunction

-adolescents
-no response to asthma meds
-flat inspiratoy loop of PFTs
-adduction vocal cords with inspiration

12

Psychogenic cough

-increased with stress
-inc with attention to cough
**-absent during sleep**
-brassy or honking in quality

13

ASthma risk index:

1) children with 4 or more episodes wheezing/year
-last>1 day
-affect sleep
2) most likely asthma with
-1 or more risk factors: parental hx, atopic dermatitis, sensitization to aeroallergens
-2 minor risk factors: sensitization to foods, >4% eosinophils, wheezing not associated with URIs

14

Categories of asthma severity:

1) intermittent
2) mild persistent
3) moderate persistent
4) severe persistent

15

*intermitent persistent asthma:

-<=2days/week & 0 nights/mo
-NO problems with normal activity
-RISK: 0 to 1/year
-Step1 tx: SABA PRN

16

*mild persistent asthma

-3-6days/week & 1-2nights/mo
-minor limitation with normal activity
-RISK: 2 or more/6mo or >=4 episodes of wheezing/yr with risk ractors for asthma
-Tx: low dose ICS

17

*moderate persistent asthma

-daily & 3-4nights/mo
-some limitation with normal activity
-RISK: 2 or more/6mo or >=4 episodes of wheezing/yr with risk ractors for asthma
-Tx: med dose ICS and consider short course OCS

18

*severe persistent asthma:

-throughout & >1night/week
-extremely limited with normal activity
--RISK: 2 or more/6mo or >=4 episodes of wheezing/yr with risk ractors for asthma
-Tx: med dose ICS and consider short course OCS

19

*Intermittent to persistent asthma change:

2 canisters per month
2 coughing fits per month
albuterol inhalor more than 2x per week

20

Long term asthma management goals:

1) reduce impairment
-prevent chronic symptoms
-reduce use of short acting beta2 agonist
-maintain normal lung function
-maintain normal activity level
2) reduce risk
-prevent exacerbation
-minimize need for emergency care or hospitalization
-prevent loss of lung function or reduced lung growth
-minimize adverse effects of therapy

21

Tx for asthma kids:

1) annual influenza vaccine
2) smoking cessation in family
3) dec exposure to allergens (pets, dust, cockroaches)
4) treat comorbid conditions (GE reflux, obesity, obstructive sleep apnea, allergies)

22

Medical management of asthma:

-All patient with PERSISTENT systems need long term control meds (taken daily to reduce inflammation)
-Quick relief meds

23

Long term meds

-inhaled corticosteroids (used with a spacer)
-leukotriene mods
- long acting beta 2 agonists

24

Inhaled corticosteroids:

1) most effective and consistent
2) long term
3) well tolerated
4) safe
5) MOA: reduce airway inflam
-block late phase inflammatory reaction to allergen (no effec on bronchospasm-early phase reaction)
6) full effects of meds take 4 weeks

25

Adverse effects of inhaled corticosteroids:

-thrush (rinse and spit after use)
-hoarseness
-bronchospasm
-reflex cough
-dic linear growth velocity (no effect on overall adult height)

26

Leukotriene modifiers:

1) interfere with leukotriene mediators released from mast cells, basophils, and eosinophils
2) indications:
-ALTERNATIVE (NOT PREFERRED) for mild persistent asthma
-can be used as adjunct with inhaled corticosteroids
3) less effective as adjunct med that long acting beta2 agonists

27

Long acting beta2 agonists:

1) MOA;
-airway beta2 receptor agonist
-inc cAMP concentration
=relaxes airway smooth muscle
2) duration of at least 12 hours
3) NOT USED AS MONOTHERAPY (w/ inhaled corticosteroids)
4) 12years old +

NOT USED AS RESCUE MEDICATIONS!

28

Adverse effects for long acting beta 2 agonists:

-BLACK BOX WARNING
-possible increased risk of exacerbations (NOT USED AS RESCUE MED!)

29

quick relief meds:

-short acting beta2 agonists
-anticholinergics
-systemic corticosteroids

30

Short acting beta2 agonists - drugs:

-albuterol, levabuterol, pirbuterol

31

Short acting beta 2 agonists:

1) MOA:
-prevents airway smooth muscle contraction
-leads to bronchodilation
2) onset/duration:
-effect within minutes of administration
-peak effect 15-30 min
-duration 4-6hours
3) TxX OF CHOICE FOR ACUTE SYMPTOMS
4) Prevents exercise induced bronchospsm

32

Adverse effects - short acting beta2 agonists:

-tachycardia
-tremor
-irritability
-hypokalemia

-if use >2days/week --> poorly controlled asthma

33

Anticholinergics - the drug?

-ipratropium bromide = bronhcodilation via muscarinic receptor ( NOT USED OUTSIDE IN OUTPATIET OR HOSPITAL SETTING

34

Anticholinergics -

1) MOA-reduce intrinsic vagal tone of airway by inhibiting muscarinic cholinergic receptors
2) additional benefit to short acting beta 2 agonist
-used in acute moderate/severe exacerbations in emergency care setting

35

Systemic corticosteroids: (pregnisoloneand something)

1) indications: moderate/severe asthma exacerbations
2) effects:
-improve airway responsiveness
-improve lung function
-dec risk of relapse
3) 4-6 hour onset (MUST GIVE IT EARLY)
4) ORAL is just as good as IV

36

Medication delivery how?

always with a spacer
=improves deposition in airways
-less medication deposited in mouth and throat

37

Spirometery how often for monitoring?

-every 1-2 years