Components of the atopic triad?
Allergic rhinitis, atopic dermatitis, asthma
Definition of asthma for official dx purposes and when do we do Dx testing? (from peds lecture way back, maybe FYI?)
Only do spirometry on kids >5 y/o though! Don’t do it during acute attack!
12% increase in FEV1 or FCV post bronchodilator OR >20% decline in pearl flow w/sx OR >20% increase post bronchodilator. I dunno if that’s important. Who knows?!?! Usu asthmatics get sx before age 5 and it’s usu misdiagnosed!!!
Key points about LABAs and differences btw Salmeterol and Fometerol
- Both reduce the am’t of steroids you need to take
- Never use LABA’s w/o access to SABA rescue inhaler too of course
- Salmeterol is slower onset, Fomoterol is rapid onset
Definition of asthma?
Intermittent, reversible airway obstruction, chronic airway inflamm, bronchial hyper-responsiveness (+/- mucus build up )
Sx of asthma?
Coughing, usu nocturnal. Usu seasonal or response to specific exposures or duration
Common triggers of pediatric asthma?
URI, exercise, weather, stress, irritants (tobacco, pets, cockroaches!?!?!, mold, etc), meds (BB, ASA, NSAIDS)
What to give kiddo w/asthma first? know doses!!
SVN w/Albuterol (salbumamol): -0.083%, .15mg/kg
–min dos: 2.5 mg.
–max dose: 5mg)
–Q 20-30mins, up to 3 doses
(monitor vitals to assess efficacy and watch SE’s like tachycardia)
+/- Ipratropium (Anticholinergic) for second round of administration PRN
What do you do after administering SABA to patient?
Do it again unless Sx completely resolve! (up to 3x)
How do you begin management of a little wee tot with asthma? (Remember doses!)
Either: Albuterol HFA inhaler w/spacer 90mcg/spray dosed 1-2 puffs q 4-6hrs
OR: Albuterol Sulfate sol’n for nebulizer
SE’s: tachycardia, shakiness, HA, dizziness
AND Glucocorticoid: Prednisolone 15mg/5ml or Prednisone oral 5mg/5ml dosed 1-2 mg/kg/d in divided doses for 3-5d. SE’s: anxiety, agitation, insomnia, hunger, etc.
Now the child has nighttime symptoms and his business is not being dealt with by the SABA and steroid. What next? (remember doses)
-Now you move to the low dose inhaled glucocorticoid OR (leukotriene R antagonist) Montelukast or Chromolyn
(More on leukotriene R antagonists on next card)
Everything about Leukotriene R antagonists
- Indications: asthma, allergic rhinitis, exercise induced bronchospasm
- -Dosing for 1-6 y/o: 4mg QD
- -Dosing for 6-15 y/o: 5mg QD
- -Dosing for >15 y/o: 10mg QD
- -SE’s: URI, F, HA, MOOD CHANGE/DEPRESSION, VASCULITIS
What to do if current tx no longer working?
D/C and go to recommended tx for that level of asthma (if doing an alternative to 1st line, like using Monoleukast instead of inhaled low dose glucocorticoid) before going up a level.
Everything about low dose ICS
Fluticasone HFA (Flovent)
- -44mcg/inhalation, 2 puffs BID
- -Don’t use the Diskus for kids
What does COPD looks like?
inc AP diameter, thin, wheezing, crackles, rhonci, sputum, cough, you get the idea. Can have an exacerbation…
Tx for ACUTE COPD exacerbation?
- Bronchodilator (SABA and +/- SAMA)
- Glucocorticoids–Prednisone 40mg PO d for 5d
- ABX, Macrolide or Fluoroquinolone 1st. (b/d usu H. flu, S. penuemo, M. catt, Pseudomonas involved. )
- -She also said give the old guy: Albuterol/Ipratroprium combo SVH (then recheck vitals, PE)
- F/U in 2-3d if not improving. F/U in 2 wks to check PFT’s and recheck BP.
Everything about Albuterol
- SABA (B2)
- For RESCUE
- onset in 20 mins, works for 4-6hrs
- SE: nervousness, shaky, inc HR, upset stomach, insomnia
-lasts up to 12hr
SE: same as SABA plus thrush and hoarseness d/t steroid
Tiotroptrium & Ipratroprium
-Anticholinergics (antimuscarinic/muscrarinic R antagonists)
-Ipratroprium bromide is short acting and cab be a rescue too. 4x/d
-Tiotroprium bromide is long acting. Not for rescue. Once daily
SE’s for both: HA, DRY MOUTH, HOARSNESS, cough, N, blurred vision, dizziness
Criteria for O2 therapy for COPD
indicated if pO2