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Asthma in Children for undergraduate students .pdf

Abbas Mushtaq Ali
Abbas Mushtaq Ali

Asthma in Children for undergraduate students

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Asthma in Children
Is a Chronic Inflammatory Disorder of The Airways; In Susceptible Individuals, This Inflammation Causes Recurrent Episodes of Wheezing, SOB, Chest Tightness & Coughing, Particularly at Night or Early in The Morning. These Episodes Are Usually Associated With Widespread But Variable Airflow Obstruction That Is Often Reversible Either Spontaneously or With Treatment. Overview Breast-Feeding & Wheezing Illness Exposure To House Dust Mite & Pets Antibiotics (1sr Year) & Intestinal Flora Genetics WHO DEVELOPS ASTHMA? (Risk Factors) When Exposure to a Trigger: Increased Mucus Production Mucosal Swelling Bronchial Muscle Contraction Pathophysiology Activated Mast Cells & Lymphocytes Produce Pro-Inflammatory Cytokines (Histamine, Leuko-Trienes, PAF) Which Are Increased in Asthmatics (Airways & Bloodstream) Inflammatory cytokines Cough (Dry Cough Especially at Night) Wheezing Increased Work of Breathing Anxiety Restlessness Oxygen Desaturation (Cyanosis) SOB Presentation Danger Signs in Acute Asthma: 1. Cyanosis 2. Exhaustion 3. Inability to Talk 4. Silent chest 3- ' 揃
Dx. 1- Hx. 2- Examination 3- Ix. CXR (Not Routinely Indicated) Spirometer (Usually Cant Do in Pediatric Age Group) CBC PSo2 4- Empirical Medication (B2 Agonist Salbutamol) Indication of CXR: A. First Attack Of Asthma B. Suspected of Chest or Respiratory Infection (Pneumonia) C. Poor Response After Treatment of Asthmatic Patient D. Sudden Acute Asthma Crisis After Good Response For Medication 1- Supportive (ABC) High Flow Oxygen Fluid Therapy (Over-Hydration May Lead to Pulmonary Edema) Antibiotics (Antibiotics are not routinely indicated) If There Fever Give (Paracetamol) 2- Pharmacology A. Conventional General -Agonists (Salbutamol, Epi-Nephrine & Terbutaline) Steroids Anticho-Linergics B. Advanced Mechanical ventilation C. Unusual/Unproven Theophylline, Magnesium LTRAs(Leukotriene receptor antagonists), Heliox Bronchoscopy Hydrocortisone 4-8 mg/kg x 1, then 2-4 mg/kg q 6属 Methyl-Prednisolone 2 mg/kg x1, then 0.5-1 mg/kg q 4-6属 Just For 5 Days Steroids Are Mandatory Element of 1st Line Therapy Regimen (few exceptions only) Inhaled Corticosteroids 1. Beclamethasone 2. Flunisolide 3. Triamcinalone Treatment In All Case Of Respiratory Cases However, In The Absence of Symptoms At The Time of A Physical Exam Does Not Exclude An Asthma Diagnosis nebulizers Bronchodilators Albuterol (Salbutamol) Salmeterol Terbutaline Side effects Tachycardia Agitation & Tremor > 6M Hypokalemia Mild Intermittent Mild Persistent Moderate Persistent Severe Persistent Day Symptoms Nights Symptoms PEF or FEV1* <2 symptomatic episodes/week 3-6 symptomatic episodes/week Daily symptoms Continual symptoms <2 nights/month 3-4 nights/month >5 nights/month Frequent >80% >60%- <80% <60% >80%
A mother brings her 9-year-old boy to your clinic because he has been complaining of being tired in physical education class at school for the past few months. When you ask him about his symptoms, he reports having trouble catching his breath after he runs. Past medical history is negative, and a review of systems reveals only a cough that occurs primarily at night several times a month. He has grown well, and findings on physical examination are normal. Of the following, the MOST likely reason for his exercise intolerance is A. cystic fibrosis B. exercise-induced asthma C. iron deficiency anemia D. vocal cord dysfunction E. Wolff-Parkinson-White syndrome WARN %

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Asthma in Children for undergraduate students .pdf

  • 2. Is a Chronic Inflammatory Disorder of The Airways; In Susceptible Individuals, This Inflammation Causes Recurrent Episodes of Wheezing, SOB, Chest Tightness & Coughing, Particularly at Night or Early in The Morning. These Episodes Are Usually Associated With Widespread But Variable Airflow Obstruction That Is Often Reversible Either Spontaneously or With Treatment. Overview Breast-Feeding & Wheezing Illness Exposure To House Dust Mite & Pets Antibiotics (1sr Year) & Intestinal Flora Genetics WHO DEVELOPS ASTHMA? (Risk Factors) When Exposure to a Trigger: Increased Mucus Production Mucosal Swelling Bronchial Muscle Contraction Pathophysiology Activated Mast Cells & Lymphocytes Produce Pro-Inflammatory Cytokines (Histamine, Leuko-Trienes, PAF) Which Are Increased in Asthmatics (Airways & Bloodstream) Inflammatory cytokines Cough (Dry Cough Especially at Night) Wheezing Increased Work of Breathing Anxiety Restlessness Oxygen Desaturation (Cyanosis) SOB Presentation Danger Signs in Acute Asthma: 1. Cyanosis 2. Exhaustion 3. Inability to Talk 4. Silent chest 3- ' 揃
  • 3. Dx. 1- Hx. 2- Examination 3- Ix. CXR (Not Routinely Indicated) Spirometer (Usually Cant Do in Pediatric Age Group) CBC PSo2 4- Empirical Medication (B2 Agonist Salbutamol) Indication of CXR: A. First Attack Of Asthma B. Suspected of Chest or Respiratory Infection (Pneumonia) C. Poor Response After Treatment of Asthmatic Patient D. Sudden Acute Asthma Crisis After Good Response For Medication 1- Supportive (ABC) High Flow Oxygen Fluid Therapy (Over-Hydration May Lead to Pulmonary Edema) Antibiotics (Antibiotics are not routinely indicated) If There Fever Give (Paracetamol) 2- Pharmacology A. Conventional General -Agonists (Salbutamol, Epi-Nephrine & Terbutaline) Steroids Anticho-Linergics B. Advanced Mechanical ventilation C. Unusual/Unproven Theophylline, Magnesium LTRAs(Leukotriene receptor antagonists), Heliox Bronchoscopy Hydrocortisone 4-8 mg/kg x 1, then 2-4 mg/kg q 6属 Methyl-Prednisolone 2 mg/kg x1, then 0.5-1 mg/kg q 4-6属 Just For 5 Days Steroids Are Mandatory Element of 1st Line Therapy Regimen (few exceptions only) Inhaled Corticosteroids 1. Beclamethasone 2. Flunisolide 3. Triamcinalone Treatment In All Case Of Respiratory Cases However, In The Absence of Symptoms At The Time of A Physical Exam Does Not Exclude An Asthma Diagnosis nebulizers Bronchodilators Albuterol (Salbutamol) Salmeterol Terbutaline Side effects Tachycardia Agitation & Tremor > 6M Hypokalemia Mild Intermittent Mild Persistent Moderate Persistent Severe Persistent Day Symptoms Nights Symptoms PEF or FEV1* <2 symptomatic episodes/week 3-6 symptomatic episodes/week Daily symptoms Continual symptoms <2 nights/month 3-4 nights/month >5 nights/month Frequent >80% >60%- <80% <60% >80%
  • 4. A mother brings her 9-year-old boy to your clinic because he has been complaining of being tired in physical education class at school for the past few months. When you ask him about his symptoms, he reports having trouble catching his breath after he runs. Past medical history is negative, and a review of systems reveals only a cough that occurs primarily at night several times a month. He has grown well, and findings on physical examination are normal. Of the following, the MOST likely reason for his exercise intolerance is A. cystic fibrosis B. exercise-induced asthma C. iron deficiency anemia D. vocal cord dysfunction E. Wolff-Parkinson-White syndrome WARN %