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Flashcards in Peds Asthma Deck (61):
1

What is the purpose of a spacer with an albuterol inhaler?

Improves deposition in the airways

2

What is the use of a neb?

For younger kids less than 5 yo

3

What are the drugs that are used for asthma?

Beta agonist with ipratropium bromide

4

When are steroids indicated for asthma?

Exacerbations

5

What is the use of fluticasone?

*Long term* control of asthma

6

When is a CXR indicated for asthma exacerbation? What if this is normal?

If not better after 3 albuterol nebs.

Continue if normal

7

How many times should beta agonists/ipratropium be given prior to changing to something else? What should be done next?

x3, then switch to a continuous administration of beta agonist, and steroids

8

What happens to the lungs with chronic asthma?

-Flattening of the diaphragm
-Hyperinflation of the lungs

9

In whom is asthma more common? (3)

-Blacks
-Hispanics
-Inner city

10

What are the trends of asthma?

Increasing incidence

11

What indicated poor control of asthma?

-2 or more hospitalizations in the past year
-more than 3 ED visits in the past year
-More than 2 canisters/month

12

What are transient wheezers?

Pts who wheeze secondary to a LRTI prior to age 3, but then resolve

13

Who are nonatopic wheezers? What is the relation between these patients and RSV?

Patients who have increased airway reactivity and continue to wheee after 3 years of age, but may resolve over time

Have an increased incidence of RSV

14

Who are atopic wheezers? What ab levels are elevated in this group? What are their lung functions like?

Pts with a family h/o asthma and are likely to have asthma

Elevated IgE
More profound lung function deficits

15

What percent of children's asthma resolved by adulthood?

60%

16

What percent of asthmatic children convert to severe asthma in adulthood

30%

17

What are the ideas behind the hygiene hypothesis?

Absence of exposure increases Th2 responsiveness

18

How do you diagnose asthma? (3)

-Recurrent episodes of airway hyperresponsiveness and obstruction
-Partially reversible
-Exclude other diagnoses

19

True or false: coughing may be the only symptom of asthma

True

20

What is the usual wheezing type with asthma? Is this always present?

Expiratory

Not always present

21

What are the two major meds that exacerbate asthma?

NSAIDs
Beta blockers

22

Why does ASA cause asthma exacerbation?

Shunts arachidonic acid to leukotrienes, which increases bronchoconstriction

23

What happens to the expiratory phase with asthma?

Prolonged

24

What is pulsus paradoxus?

an abnormally large decrease (10 mmHg) in systolic blood pressure and pulse wave amplitude during inspiration

25

What causes the palpable liver and spleen with asthma?

Hyperinflation of the lungs

26

What is the obstructive pattern of spirometry (values)?

FEV1 less than 0.8
FEV1/FVC less than 65%

27

How helpful are labs with asthma? What will these show?

Not at all.

Elevated IgE
Eosinophilia

28

What are the CXR findings with asthma? (4)

-hyperinflation
-Peribronchial thickening
-atelectasis
-pneumothorax

29

What are the defining characteristics of a psychogenic cough?

-Will completely disappear at night
-Increased with attention to cough

30

What age group is most commonly affected with vocal cord dysfunction?

Adolescents

31

What is vocal cord dysfunction?

Paradoxical movement of the vocal cords during inspiration

32

What are the PFT findings of vocal cord dysfunction?

Flat inspiratory loop on PFTs, with no response to asthma meds

33

What are the four types of asthma?

-intermittent
-mild persistent
-moderate
-severe persistent

34

At what point do you put kids on inhaled steroids?

More than mild persistent asthma

35

How do you categorize asthma severity? (4)

-Frequency/ssx
-Frequency of beta 2 agonist use
-Degree of interference with activity
-PFTs

36

What are the characteristics of intermittent asthma, and is appropriate for PRN beta 2 agonist use? (days/week and nighttime ssx)

-Less than 2 days per week
-No nighttime ssx

37

What are the characteristics of mild persistent asthma?

-3-6 days/week
-1-2 night time
-minor limitation

38

What is the treatment for mild persistent asthma?

low dose ICS

39

What are the FEV1 and FEV1/FVC for intermittent asthma kids? MIld persistent

LFEV1 greater than 80 for both

FEV1/FVC greater than 85 for intermittent, greater than 80 for mild persistent

40

What are the prophylactic treatment for asthma? (3)

-Flu vaccine
-smoking cessation
-Treat comorbidities

41

True or false: all patients with persistent symptoms should be started on long term controller medications

True

42

Do antileukotrienes take the place of ICS?

No

43

How long does it take for ICS to take full effect?

4 weeks

44

Why do you need to rinse and spit after ICS use?

May develop thrush

45

What is the use of leukotriene modifiers?

Alternative treatment for mild, persistent asthma

46

Do LABAs work acutely?

No

47

What is the severe side effect of LABAs?

Sudden cardiac death

48

What are the side effects of SABAs?

-Tachycardia
-Tremor
-Irritability
-Hypokalemia

49

When are anticholinergics used for asthma?

Used in the ED only

50

Are SABAs okay to be used scheduled daily?

No

51

What are the indications for systemic corticosteroids?

Moderate to severe asthma exacerbation

52

True or false: IV and PO corticosteroids are equally efficacious in treating asthma

True

53

How do you monitor asthma?

-PFTs

54

Wheezing before 3 years of age is associated with what?

LRTIs

55

Children with (__) or more episodes of wheezing/year are more likely to develop asthma?

More than 4

56

Major or minor risk factor for asthma: Parental h/o asthma

Major

57

Major or minor risk factor for asthma: h/o atopic dermatitis

Major

58

Major or minor risk factor for asthma: sensitization to foods

Minor

59

Major or minor risk factor for asthma: greater than 4 % eosinophils

Minor

60

Major or minor risk factor for asthma: Wheezing not associated with URIs

Minor

61

Major or minor risk factor for asthma: sensitization to aeroallergens

Major