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Childhood Asthma
Childhood Asthma
Childhood Asthma
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Chronic
cause
Wheezing
Breathlessness
Chest tightness
Nighttime or early morning coughing
Episodes
Allergens
Infections
Exercise
Abrupt
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Recurrent
Shortness of breath
Coughing
Wheezing
Chest pain or tightness
Range
in severity from
Mild intermittent
Severe persistent
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Increases
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10.1% Overall
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By
gender
race/ethnicity
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Current
among
children than adults
boys than girls
women than men
Asthma
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Groups
Wheeze
> 4 attacks
(0.1 - 4.7)
Night Cough
6 - 7 Yrs
5.6 %
1.5%
(0.5 - 3.5)
12.3%
(3.3 - 27)
(0.8 - 14.6)
13-14 Yrs
6.0%
(1.6 - 17.8)
1.6%
14.1%
(3.8 - 32.2)
3.7%
Ever had Asthma
(1.0 - 14.4)(1.12.4)
4.5%
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Parental Asthma
Allergy
Atopic dermatitis
Allergic rhinitis
Food allergy
Inhalant allergen sensitization
Food allergen sensitization
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Animal dander
Dust mite
Cockroaches
Molds
Pollen
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Air pollutants
Ozone
Sulfur dioxide
Particulate matter
Dust
Tobacco smoke
Strong/ noxious fumes
Cold, dry air
Exercise
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Occupational exposures
Farm and barn exposure
Formaldehyde, paint fumes
Crying, laughter,
hyperventilation
Co morbid conditions: Rhinitis,
Sinusitis
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Symptoms:
Intermittent dry cough
Expiratory wheezing
Shortness of breath
Chest tightness
Chest pain
Fatigue
Difficulty keeping up with peers in
physical activities
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Signs:
Expiratory wheezing
Prolonged expiratory phase
Decreased breath sounds
Crackles/ rales
Accessory muscle use
Nasal flaring
Absence of wheezing in severe
cases
Pulses paradoxus
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Spirometry:
Feasible
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Airflow Limitation:
Low FEV1
FEV1/ FVC ratio < 0.80
Bronchodilator response to -agonist:
Improvement in FEV1 12%
Exercise challenge:
Worsening of FEV1 15%
Daily peak flow or FEV1 AM-PM variation
20%
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Often
normal
Hyperinflation
Helpful in identifying masqueraders
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Asthma severity:
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Develop
with a physician
Tailor to meet individual needs
Educate patients and families about
all aspects of plan
Recognizing symptoms
Medication benefits and side effects
Proper use of inhalers and Peak Expiratory Flow
(PEF) meters
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Breathless
at rest
Hunched forward
Speaks in words rather than complete
sentences
Agitated
Peak flow rate less than 60% of normal
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All
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Salmeterol, Formoterol
Not used as monotherapy
Major role as ad-on agents with ICS
LABA use should be stopped once optimal
Asthma control is achieved
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Cromolyn, Nedocromil
Inhibit exercise induced bronchospasm
Can be used in combination of SABA for
exercise induced bronchospasm
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Dyspnea at rest
Peak flows < 40% of personal best
Accessory muscle use
Failure to respond to initial treatment
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Brief assessment
Administration of SABA: Repeated doses or
continuously, every 20 mins. for 1 hour
Inhaled anticholinergic in addition of SABA
Oxygen: Hypoxemia/ moderate to severe
exacerbation
Systemic Corticosteroids: Instituted early
for moderate to severe exacerbation and
failure to respond to early treatment
Intramuscular beta agonist in severe cases.
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