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Pediatric Asthma

Presentation on asthma explaining the pathophysiology, investigations, diagnosis, assessment, control and prognosis of asthma

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Pediatric Asthma

  1. 1. •70-80% before 5 years of age Onset • only 1/3rd of all wheezers have asthma Progression
  2. 2. RespiratoryViral Infection EnvironmentalAllergens Exercise Emotional Stress
  3. 3. Airflow obstruction Bronchial Hyper- responsiveness Chronic inflammation
  4. 4. Early phase : immediate response Late-phase : 6 to 24 hours
  5. 5. Consistent with Asthma Not consistent with asthma
  6. 6. Major Risk Factors Minor Risk Factors Parental Asthma Allergic Rhinitis Wheezing without URTI Eczema Eosinophilia >4% Loose Index Stringent Index 1 episode of wheezing in 3 years + 1 major > 3 episode of wheezing in 3 years + 1 major 1 episode of wheezing in 3 years + 2 Minor > 3 episode of wheezing in 3 years + 2 Minor Conclusion: Conclusion 2.6-5.5 times likely to have asthma 4.3 – 9.8 times likely to have asthma
  7. 7. Viral Associated wheeze Early Onset Asthma Febrile Episodes Afebrile episodes No Personal Atopy Positive Personal Atopy No Family history of atopy Positive Family history of atopy Variable response to bronchodilators Predictable response to bronchodilators
  8. 8. History Of presenting Illness Age • Birth • Early infancy • Early Childhood • Adolescents Associated symp. • Choking • Fever • Feeding onset • New or recurrent Temporal Pattern • Episodic or persistent Control of wheeze • Difficult to control Past Medical History • Recurrent pneumoniae • Neurodegenerative disease Birth History • Antenatal Antenatal USS. • Natal Preterm Family history • Atopy
  9. 9. General Examination: Denny morgan lines allergic salute Clubbing Erythematous conjuntiva Growth Charts : Weight: Underweight Length: Short stature Head circumference: Macro or microcephaly Vital Signs Temperature: fever Systemic Examination: Skin: Urticaria Eczema ENT: Boggy turbinates Rhinorrhea Polyps Stridor CNS: Features of neurodegenerative diseases Chest: Increased AP Local vs generalized Inspiratory vs expiratory
  10. 10. PFTs (diagnostic) CXR (Rule out other causes) RAST Other: CBC Sweat Chloride , immunoglobulins,Viral screen Barium Swallow
  11. 11. FEV1 FEV1/FVC FEF25-75 FVC Flow volume Loop
  12. 12. PFTs Result TLC Increased or normal RV Increased FVC Reduced
  13. 13. PFTs Result FEV1 Reduced FEV1/FVC Reduced FEF25-75 Reduced
  14. 14. 1. recurrent episodic symptoms of airflow obstruction 2. Airway flow obstruction is at least partially reversible by administration of a bronchodilator. 3. Alternative diagnoses are excluded Symptoms are often worse at night or on waking Symptoms occur variably over time and vary in intensity Symptoms are often triggered by exercise, laughter, allergens, virus
  15. 15. Cystic fibrosis FBA Vascular ring Immune dysregulation Swallowing dysfunction GERD
  16. 16. • Minimal need <2/wk for SABA • Maintenance of normal daily activities Reduction in impairment • Prevention of recurrent exacerbations • minimal or no adverse effects of drugs Reduction of risk
  17. 17. Intermittent Persistent Mild Moderate Severe Asthma Severity is classified into 3 categories:
  18. 18. Control Well Controlled Not well Controlled Poorly controlled
  19. 19. signs and symptoms pulmonary function quality of life exacerbations adherence to treatment medication side effects
  20. 20. COMPONENETS OF SEVERITY SEVERITY INTERMITTENT PERSISTENT MILD MODERATE SEVERE IMPAIRMENT DAY <2 times/ week >2 times/ week DAILY FREQUENT SABA USE <2 times/ week >2 times/ week DAILY FREQUENT NIGHT <2 times/ MONTH >2 times/ MONTH >5 times/ MONTH FREQUENT ACTIVITY NONE MINOR SOME EXTREME >80% >60 <60% LUNG FUNCTION >5YEARS FEV1% PREDICTED >80% FEV1/FVC RATIO >85 >80% >75 <75% >12y = NORMAL NORMAL REDUCED 5% REDUCED 5% RISK EXACERBATIONS <2TIMES /YEAR >2TIMES /YEAR
  21. 21. COMPONENETS OF CONTROL CONTROL WELL NOT WELL VERY POOR IMPAIRMENT DAY <2 times/ week >2 times/ week FREQUENT SABA USE <2 times/ week >2 times/ week FREQUENT NIGHT <2 times/ MONTH >2 times/ MONTH >5 times/ MONTH ACTIVITY MINOR SOME EXTREME >60% <60% LUNG FUNCTION >5YEARS FEV1% PREDICTED >80% FEV1/FVC RATIO >80% >75 <75% RISK EXACERBATIONS <2TIMES /YEAR >2TIMES /YEAR
  22. 22. Medication Physician factor Patient variables
  23. 23. COMPONENETS OF SEVERITY SEVERITY INTERMITTENT PERSISTENT MILD MODERATE SEVERE RECOMMENDED STEPS FOR INTIATING THERAPY STEP1 STEP2 0-4 y STEP3 STEP3 5-11y STEP3 STEP3-4 >12y STEP3 STEP4-5 CONSIDER SHORT DOSE OF STEROIDS
  24. 24. Step: Step1 Step2 Step3 Step4 Step5 Step6 0-4y P SABA prn Low ICS Medium ICS Medium ICS + LABA or LTRA High ICS +LABA or LTRA High ICS +LABA or LTRA+steroids A LTRA 5-11y P SABA prn Low ICS Medium ICS or Low dose ICS + LABA, LTRA Medium ICS+LABA or LTRA High ICS +LABA or LTRA High ICS +LABA or LTRA+steroids A LTRA theophylline theophylline theophylline theophylline >12y P SABA prn Low ICS Medium ICS or Low dose ICS +LABA or LTRA Medium ICS+LABA or LTRA High ICS +LABA or LTRA High ICS +LABA or LTRA+steroids A or LTRA Theophylline, Zileuton Theophylline, Zileuton Omalizumab Omalizumab
  25. 25. 3. leukotriene modifiers, 4. mast cell stabilizers i.e Cromolyn 5. Omalizumab
  26. 26. >5Y Allergen specific RAST or skin prick Incremental doses

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