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

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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

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