Childhood Asthma
Childhood AsthmaA triad of atopic eczema, allergic rhinitis and
asthma is called atopy.[53] The strongest risk factor for
developing asthma is a history of atopic diseaseMost common chronic
disease of childhoodBegins under 5 years300 million worldwide, 5
million children in US = 3-7 % 250K deaths annuallyMiss 3 X days
school
1Acute Exacerbations Outpatient ManagementHow
sick?Drugs?Doses?DeferFollow up
2History & PhysicalTime onsetMeds usedLast -agonist useHigh
risk factors for severityExam:VS / O2 sat / mental status /
Respirations: Wheeze/accessory muscles/stridor/retractions
3PSI
Score: 0-157-11 Moderate> 12 Severe
4AssessmentInitial evaluationRespiratory treatmentRefer for
admission?
5ToolsPSIPERF (peek expiratory flow rate )Hard if less than 6
years3 tries standingPrevious best most helpfulCXR: usual trigger
viral, low yield unless focal findings such as rales or decreased
BS, >39ABGs rarely needed acutely, O2%sat good
6
7Goals of TreatmentReverse airway obstructionCorrect
hypoxemiaReduce recurrences by intensifying baseline treatment
8Specific TreatmentKeep O2 > 92 %Frequent monitoring patient
status
9Outpatient Treatment of Mild ExacerbationsModerate and severe
best treated in EDMild PSI < 7Beta agonist first
lineCorticosteroids in unresponsive to agonist treatmentCan add
ipratropium to nebulizer treatments
10