Childhood asthma

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child hood asthma

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  • 1. Childhood AsthmaDr.Rajesh.K

2. Definition: a chronic inflammatory disorder of theairways resulting in recurrent episodes ofwheezing,breathlessness,chest tightness andcough,particularly at night and in the earlymorning and may relieved by abronchodilator. 3. The inflamation also causes increased airwayhyperreactivity to a variety of stimuli like viralinfections,cold air,exercise,emotions,allergenspollutants .conditions such as aspiration, GERD, airwayanomaly, foreign body, cystic fibrosis, vocal corddysfunction, etc have been ruled out 4. Clinical manifestations cough,increased work ofbreathing{tachypnea,retractions or accessorymuscle use},wheezing,hypoxiaandhypoventilation No audible wheezing may indicate very poorair movement and severe broncho spasm Chest X-ray shows peribrochialthickening,hyperinflation,and patchyatelectasis. 5. Consider diagnosis of persistent asthma ifrecurrent episodes cough with or without wheezeCough that is associated with exercise/playsymptoms greater than 2 days per week.night awakenings greater than 2 times per monthsecondary to asthmapatients require more than 2 steroid bursts per yearFEV1 6 (6-9)--severe 9. Intial management Give o2 to keep saturation>95% Administer inhaled B-agonists:nebulizedalbuterol,0.05 to 0.15mg/kg/dose as oftenneeded. Ipratropiumbromide,0.25 to 0.5mg,nebulizedwith albuterol acts to decrease airway secretions. Benefit has been demonstrated only formoderate to severe exacerbations and its effect isnot titrable(give early but no benefit has beenshown from repeated doses) 10. Steroids:methylprednisolone,2mg/kg IV/IMbolus,then 2mg/kg/day divide every 6hr orprednisone 2mg/kg PO every 24hr requireminimum of 3hrs to take effect. If airmovement is still poor despite maximizingabove therapy. 1.epineprine:0.01ml/kg SC or IM(1:1000:maxdose,0.5ml)every 15 min up to 3doses. 11. i.bronchodilator,vasopressor and inotropic effects. ii.short acting (15min) and should be used astemporizing rather than definitivetherapy. 2.MgSo4:25-75mg/kg/dose iv or im(max2g) infusedover20min every 4-6hr up to 3-4doses smooth muscle relaxant,relieves bronchospasm,C/I ifpatient is in Hypotension or Renalfailure. Saline bolus can be given prior to administration toavoid hypotention. 12. 3.terbutaline:0.01mg/kg SC(max 0.4mg) every15min upto 2doses. Systemic b2 agonist limited by cardiacintolerence. Monitor continuous ecg,cardiacenzymes,urine analysis,electrolytes 13. TreatmentIntermittent Asthma Step 1 (all ages): Short acting beta agonist (e.g. salbutamol) If symptoms greater than 2 days per week(other than exercise induced symptoms)patient is not well-controlled and the next stepneeds to be considered 14. Long term management of asthma Goals: Maintenance of near normal physical activity. Maintenance of near normalpulmonaryfunction. Prevention of night time cough or wheezingwith minimal chronic symptoms. Prevention of exacerbation of asthma. Avoinding adverse effects of medication. 15. The effective long term management ofasthma involves 3 major areas. Identification and elimination of exacerbatingfactors. Drug therapy Parental education. 16. pharmacotherapy For Long term management: SABA:adrenaline,terbutaline,salbutamol LABA:salmeterol,formoterol. Corticosteroids:beclomethasone,budesonide,fluticasone. 17. Assessing controlWell-controlled asthmadaytime symptoms less than 2 days per weeknight awakenings secondary to asthma less than 2 timesper monthability to perform activities without limitationsless than 2 steroid bursts per yearFEV1 greater than or equal to 80% predictedFEV1/FVC 80% (>5 years old) and 85% (8-19 years old)Consider stepping down regimen if patient has beenwell-controlled for 3 months or more consecutively andreassess every 3-6 monthsRefer to specialist if control cant be obtained in 3-6months using step guidelines or if patient has 2 or moreemergency room visits or hospitalizations in 1 year