Pediatric Asthma Flashcards
(99 cards)
1
Q
At what age are patients most vulnerable to asthma exacerbations that require hospital care?
A
young children
2
Q
What is the main underlying complication of asthma?
A
airway inflammation
3
Q
List the steps of an asthma exacerbation.
A
- initial airway bronchoconstriction
- airway edema and exaggerated mucus production
- airway hyper responsiveness
- chronic changes in airway epithelium
4
Q
Pro-inflammatory cytokines are produced primarily by what?
A
Th 2 lymphocytes
5
Q
What is believed to trigger the intense inflammation of allergic asthma?
A
pro-inflammatory cytokines
6
Q
What cells are thought to be out of balance in chronic inflammatory asthma?
A
Th 1 and Th 2
Th 1 being decreased and Th 2 being increased
7
Q
What is the function of chemokines?
A
These proteins recruit pro-inflammatory cells, including Th2 lymphocytes, mast cells, neutrophils, and eosinophils
8
Q
Which antibody subtype plays a large role in asthma?
A
IgE
9
Q
What are the risk factors for developing asthma?
A
- male
- parental asthma
- allergies
- severe LRI
- tobacco smoke exposure
- wheezing apart from colds
10
Q
What are the 3 distinct wheezing phenotypes?
A
- transiet
- non-atopic
- atopic
11
Q
All children who wheeze develop asthma. (T/F)
A
False
12
Q
What is the most common cause of LRI?
A
respiratory syncytial virus (RSV)
13
Q
What is transit wheezing?
A
Infants whose wheezing is associated with one or more LRIs and who cease to wheeze after 3 years of age
14
Q
What is non-atopic wheezing?
A
- Children who have relatively more reactive airways
- a higher incidence of previous RSV infection
- persistent wheezing after 3 years of age, which may resolve over time.
15
Q
What is atopic wheezing?
A
- have higher IgE concentrations
- prone to allergen-mediated airway hyperresponsiveness
- more profound lung function deficits at an early age
16
Q
What type of wheezer is most likely to develop asthma?
A
atopic
17
Q
At what age can a child be diagnosed with asthma?
A
5
18
Q
What is the Asthma Predictive Index?
A
A tool used to “diagnose” children under 5 with asthma. Since this is not a definitive diagnosis, it technically predicts that the child will develop resistant asthma after age 5.
19
Q
What are the criteria for a < 5 yo to get a positive on the Asthma Predictive Index?
A
- If < 3 and have ≥ 4 wheezing episodes in past year
- AND one of the following
• parental history of asthma
• diagnosis of atopic dermatitis
• evidence of sensitization to aeroallergen - AND two of the following
• evidence of sensitization to food
• ≥ 4% peripheral blood eosinophilia
• wheezing apart from the common cold
20
Q
What are symptoms likely due to asthma?
A
- wheezing
- cough, particularly at night
- difficulty breathing
- tachypnea
- episodic cough, SOA, chest tightness
21
Q
What is wheezing?
A
high pitched whistling sound when breathing out
22
Q
What are the 4 types of asthma?
A
- recurrent wheezing
- chronic asthma
- exercise induced
- September epidemic
23
Q
What is the primary cause of recurrent wheezing?
A
viral illness
24
Q
When does recurrent wheezing usually present?
A
early childhood
25
When does chronic asthma present?
later childhood
26
What is chronic asthma typically associated with?
allergies
27
What is exercise induced asthma?
intermittent symptoms exacerbated by physical activity
28
When does September epidemic usually present?
school age children
29
What type of wheezing is recurrent wheezing associated with?
non-atopic
30
What type of wheezing is chronic asthma associated with?
atopic
31
What is the September epidemic?
- stress associated with return to school?
- high levels of environmental allergens in late summer
- more exposure to RVIs
32
At what age is the Pulmonary Function Test appropriate?
≥ 5 years
33
What is the PFT used for?
excluding other diseases
34
Why is the PFT not valid in children under 5?
- short attention span
| - limited coordination
35
What are the types of inhalers?
- metered dose inhaler
- breath-actuated dry powder inhaler
- nebulizer
36
DPIs are ideal for young children because they are the easiest to use. (T/F)
False, young children often cannot generate enough strength in the breath to inspire the powder down into the lungs
37
Which is better for children, MDI + spacer or nebulizer?
both are equally safe and effective
38
What are the facets of care for pediatric asthma?
- classification of asthma severity
- daily management
- exacerbation management
- therapy adjustment
39
What are the main goals of therapy in pediatric asthma?
- reduce impairment
| - reduce risk
40
How do we reduce impairment in pediatric asthma?
- prevent symptoms
- infrequent use of rescue medications
- maintain near normal PFT
41
What is considered "infrequent use" of rescue medications?
≤ 2 days per week
42
How do we reduce risk in pediatric asthma?
- prevent recurrent exacerbations and hospitalizations
| - minimize ADRs
43
Describe Step 1 of asthma management for 0-4 year olds.
SABA PRN
44
In whom is Step 1 asthma therapy appropriate?
Intermittent asthma
45
Describe Step 2 of asthma management for 0-4 year olds.
Preferred: low dose ICS
Alternate: cromolyn or montelukast
46
In whom is Step 2 asthma therapy appropriate?
Mild Persistent asthma
47
Describe Step 3 of asthma management for 0-4 year olds.
medium dose ICS
48
In whom is Step 3 asthma therapy appropriate?
Moderate Persistent Asthma
49
Describe Step 4 of asthma management for 0-4 year olds.
medium dose ICS + LABA or montelukast
50
Describe Step 5 of asthma management for 0-4 year olds.
high dose ICS + LABA or montelukast
51
Describe Step 6 of asthma management for 0-4 year olds.
high dose ICS + LABA or montelukast + oral systemic corticosteroids
52
In whom is Step 4 asthma therapy appropriate?
Moderate Persistent Asthma
53
In whom is Step 5 asthma therapy appropriate?
Severe Persistent Asthma
54
In whom is Step 4 asthma therapy appropriate?
Severe persistent asthma
55
Describe Step 1 of asthma management for 5-11 year olds.
SABA PRN
56
Describe Step 2 of asthma management for 5-11 year olds.
Preferred: Low-dose ICS
Alternative: cromolyn, LTRA, Nedocromil, or Theophylline
57
Describe Step 3 of asthma management for 5-11 year olds.
EITHER
Low-dose ICS + LABA/LTRA/Theophylline
-or-
medium dose ICS
58
Describe Step 4 of asthma management for 5-11 year olds.
Preferred: Medium dose ICS + LABA
Alternative: Medium dose ICS + LTRA/theophylline
59
Describe Step 5 of asthma management for 5-11 year olds.
Preferred: high dose ICS + LABA
Alternative: high dose ICS + LTRA/theophylline
60
Describe Step 6 of asthma management for 5-11 year olds.
Preferred: High dose ICS + LABA + oral corticosteroids
Alternative: High dose ICS + LTRA/theophylline +oral corticosteroids
61
Before continuing on the the next step, what should always be checked?
- adherence
- environmental control
- management of comorbidities
62
What are the key points of patient education with pediatric asthma?
- asthma action plan
- peak flow monitoring
- symptom monitoring
- adherence
- correct inhaler techniques
63
What are the key points of the management of pediatric asthma?
- patient education
- control of environmental factors
- vaccinations
64
At what point should you consider stepping down therapy in pediatric asthma?
well controlled for > 3 months
65
What are the anti-inflammatory agents used for pediatric asthma?
- inhaled corticosteroids
- oral corticosteroids
- mast cell stabilizers
- leukotriene modifiers
66
Why would you want to use a SABA?
- provide relief of acute symptoms
- drug of choice for intermittent asthma
- prevention and management of EIA
67
What are the SABA agents?
- albuterol sulfate
- levalbuterol
- pirbuterol acetate
68
Why would you want to use a LABA?
- patients requiring scheduled β₂ agonists
- moderate to severe asthma
- adjunct to anti-inflammatory agents
- assists primarily with nocturnal symptoms
69
What are the LABA agents?
- formoterol fumigate
- salmeterol xinafoate
- *fluticasone propionate/salmeterol xinafoate (Advair)
- *budsonide/formoterol fumigate
* combo with ICS
70
What is the mainstay therapy for asthma management?
ICS
71
What are the ICS agents?
- beclomethasone
- budsonide
- ciclesonide
- flunisolide
- fluticasone proprionate
- mometasone furonate
- triamcinolone acetone
72
Do ICSs make children shorter?
Average of 1.2 cm difference (minimal)
73
Why would you want to use a Leukotriene Receptor Antagonist (LTRA)?
- long-term control and prevention of asthma exacerbations
| - added to therapy due to minimal ADRs and easy admin.
74
What is status asthmaticus?
condition of a patient in progressive respiratory failure due to asthma, in whom conventional forms of therapy have failed
75
What are the pharmacotherapy options for status asthmaticus?
- systemic corticosteroids
- bronchodilators
- magnesium
- terbutaline
- ketamine
- methylxanthines
76
Describe systemic corticosteroid use in status asthmaticus.
- drug of choice
- burst therapy for 3 - 10 days has minimal ADRs
- long term dosing (combined with decreased ICS use)
• daily (lowest possible dose
• every other day
• combined with ICS
• replace ICS
77
What are the systemic corticosteroid agents?
- dexamethasone
- methylprednisolone
- prednisolone
- prednisone
78
Which systemic corticosteroid agent solution contains alcohol?
- dexamethasone
| - prednisolone
79
In status asthmaticus, what are the bronchodilating agents?
- albuterol inhalation
| - ipratropium bromide
80
What is the dosage of MDI albuterol in status asthmaticus?
4 - 8 puffs every 20 minutes x 3 doses
81
What is the dosage of nebulizer albuterol in status asthmaticus?
2.5 mg q 20 minutes x 3 doses
82
What category does ipratropium bromide belong?
anticholinergic bronchodilator
83
There is no benefit to adding ipratropium bromide to β₂ agonist or corticosteroid therapy. (T/F)
True
84
How does magnesium treat status asthmaticus?
inhibits smooth muscle contraction by inhibiting calcium uptake causing bronchodilation
85
How is magnesium dosed in status asthmaticus?
25 - 75 mg/kg IV over 15 - 30 minutes
86
What are the ADRs of magnesium therapy?
- flushing
- nausea
- hypotension
87
What is terbutaline?
systemic β₂ agonist
88
What is the dose of terbutaline in status asthmaticus?
10 mcg/kg IV load
| 0.4 - 10 mcg/kg/min continuous infusion
89
What are the ADRs of terbutaline?
- HTN
- nervousness
- tachycardia
90
In what situation might terbutaline be used?
patient is in such a state that inhaled β₂ agonists cannot be introduced into the lungs
91
Which route of administration with terbutaline minimizes ADRs?
SQ
92
What are the methylxanthine agents?
aminophylline
93
What is the dose of aminophylline in status asthmaticus?
6 mg/kg IV load
| 0.5 - 1.2 mg/kg/hr IV
94
What are the target serum concentrations of aminophylline?
5 - 10 mcg/ ml
95
What is the therapeutic result of low serum concentrations of aminophylline?
anti-inflammatory and immune-modulary
96
What is the therapeutic result of high serum concentrations of aminophylline?
asthma MOA
97
How does ketamine treat status asthmaticus?
NMDA receptor antagonist that reduces airway resistance via bronchodilation
98
At what stage of status asthmaticus is ketamine to be used?
last line
99
What is the dose of ketamine in status asthmaticus?
1 - 2 mg/kg loading
| 6 - 10 mcg/kg/min continuous infusion
