Pediatric asthma & allergy

•• 9 month old with cough productive and clear rhinorrhea for 11 days low grade fevers, male vomits after cough and it is more severe at night time, wheezing in the office with subcoastal retractions although happy and content in moms lap-- remainder of exam normal, pulse ox 94% and respiratory rate 44 + daycare. What do you do as a provider? What questions do you want •• ? Steroid efficacy•• ? Cough suppressants •• Does your management change if the •• Not all that wheezes is asthma •• 80-90% of children with asthma develop •• Predisposition 3 X’s more likely with fmh •• Anatomic defects like vascular rings, TEF, •• Bronchitis-- usually viral (see below), however think •• Viral infections RSV, paraflu, influenza and adenovirus •• Coughing regularly especially at night or •• Older children will report chest pain •• By definition Asthma is an obstructive •• 7 year old known asthmatic has increased albuterol use over the last 5 days and is symptomatic and not sure what to do –– triggers include allergy season and she is •• Is her emergency inhaler expired or •• How is she administering the medication?•• Flovent Flovent –– do we step up or add on oral •• When?•• How?•• Who?•• Serial PFT’ss more helpful than single •• Obstructive process –– decreased FEV1 •• Statistically MDI’ss with aerochamber mask are as efficacious a delivery method •• Technique important here-- teaching a •• Both meds can show effect within in 2 •• Green (> 80% predicted peak flow) •• Yellow (50-80 % predicted Peak flow) –– if in longer than 24 hours while doing albuterol hours and not recovering seek care at office •• Red zones( < 50% predicted) give albuterol get to ER –– depending on severity may call 911 •• Peak flow teaching a Must-- low flow until about •• Best to obtain PFT’ss either 6 mo to annually depending on control starting at 5 years old •• Flu shot may consider pneumococcal vaccine •• Avoid triggers-- cold air at recess •• Meds expired??? Some have counters •• Assess for pattern•• Independent approach to each child•• Start with anti-- inflammatories •• FEV1 or PEF > 80% PEF variability < •• When to test?•• How to test –– under 3 years old pedi-rast, beyond 3 sometimes skin testing preferred •• Chipps, et al. Longitudinal Validation of the Test for Respiratory & Asthma Control in Kids in Pediatric practices. Pediatrics 2011; 127:3 •• Delgado, et al. Asthma Therapy : Metered-dose Inhalers Preferred for dose Infants and Toddlers. Arch Pediatric Adolescent Medicine 2003; 157: 76-80. original site then republication AAP Grand Rounds •• Guidelines for the Diagnosis & Management of Asthma. 2007 NIH Asthma Guidelines •• Lob, et al. Promoting Best-Care Practices in childhood Asthma: Quality Improvements in Community Health Centers. Pediatrics •• Promising Results in Practice Improvements: an update from the chapter quality network asthma project. AAP News 2011; 32:4 32--


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