Asthma 10 02

Information about Asthma 10 02

Published on January 14, 2008

Author: Sigfrid

Source: authorstream.com

Content

Asthma in Children:  Asthma in Children October 29, 2002 Swedish Family Medicine Jorge Garcia, MD Slide3:  CASE 1 An 7-year old girl has just moved into town and presents to her doctor. She has history of wheezing and rhinitis and recurrent otitis media since infancy. Over the past 2 years her symptoms have worsened. She complains of coughing and SOB daily and claims to awaken at least once a week in the middle of the night by these symptoms. Slide4:  Her family history consists of maternal asthma, and atopy in both parents. Physical exam finds inflamed nose, mild wheezing, otherwise unremarkable. The patient's mother states that her daughter was previously prescribed an albuterol puffer to use prn, which her daughter uses daily and requires monthly refills. The child is able to remain active. In the past year she has had 4 courses of prednisone. Slide5:  According to the above information: How would you classify this patient's severity? Mild intermittent Mild persistent Moderate persistent Severe persistent Slide6:  Diagnosis of Asthma Severity Diagnosis Days w/Sx Nights w/Sx PEF (Step) (% personal best) or FEV2 % predicted best) severe persistent(4) Continual Frequent <60 moderate persistent(3) Daily >5 / month 60-80 mild persistent (2) >2/wk 3 to 4 / month >80 mild intermittent (1) <2 /wk <2 per month >80 What makes you think this is :  What makes you think this is ASTHMA? SUSPECT ASTHMA WITH::  SUSPECT ASTHMA WITH: Intermittent wheezing, cough, dyspnea. Increased rate of breathing. Sx worse at night and in early morning. Associated with triggers. Onset before age 5. (80%) What is your differential?:  What is your differential? Wheezing can be caused by::  Wheezing can be caused by: URIs Rhinitis Sinusitis CF Cardiac disease GERD Foreign body aspiration... Workup?:  Workup? New Asthma Dx::  New Asthma Dx: Confirm with PFT Consider Allergy testing if the child also has significant allergic rhinitis. With the diagnosis of Asthma:  With the diagnosis of Asthma What are the findings on PFT? PFT:  PFT Increase in forced expiratory volume in one second (FEV1) of 12 percent or more after bronchodilator therapy. variable airflow obstruction (20 percent or more) with serial spirometry or peak expiratory flow (PEF). Not reliable in kids <3-4. Slide15:  CASE 1: Naomi J. An 7-year old girl has just moved into town and presents to her doctor. She has history of wheezing and rhinitis and recurrent otitis and sinusitis since infancy. Over the past 2 years her symptoms have worsened. She complains of coughing and SOB daily and claims to awaken at least once a week in the middle of the night by these symptoms. Slide16:  Her family history consists of maternal asthma, and atopy in both parents. Physical exam finds inflamed nose, mild wheezing, otherwise unremarkable. The patient's mother states that her daughter was previously prescribed an albuterol puffer to use prn, which her daughter uses daily and requires monthly refills, but the patient is able to remain active. In the past year she has had 4 courses of prednisone. What more would you want to know about your patient?:  What more would you want to know about your patient? Obtain a history to rule out triggers:  Obtain a history to rule out triggers What are some possible triggers of RAD? Obtain a history to rule out triggers.:  Obtain a history to rule out triggers. What are some possible triggers of RAD? Slide20:  dust mites and mold spores, pollen animal dander, cockroaches, indoor and outdoor pollutants, irritants (e.g., tobacco smoke, smoke from wood-burning stoves or fireplaces, perfumes, cleaning agents), pharmacologic triggers (e.g., aspirin or other nonsteroidal anti-inflammatory drugs, beta blockers and sulfites), physical triggers (e.g., exercise, hyperventilation, cold air) physiologic factors (e.g., stress, gastroesophageal reflux, respiratory infection [viral, bacterial] and rhinitis). Kitchen sink. What is the best way to treat her today?:  What is the best way to treat her today? ? “Treatment of children with asthma should begin with the most aggressive therapy necessary to achieve control, followed by "stepping down" to the minimal therapy that will maintain control.” :  “Treatment of children with asthma should begin with the most aggressive therapy necessary to achieve control, followed by "stepping down" to the minimal therapy that will maintain control.” Moderate Persistent Asthma (Step 3):  Moderate Persistent Asthma (Step 3) High dose corticosteroid inhaler daily. Long acting daily bronchodilators. Short acting bronchodilator for symptoms. Asthma treatment by severity::  Asthma treatment by severity: Step 1; mild, intermittent days with symptoms: <2 times per week nights with symptoms <2 per month PEF>80% predicted. Asthma treatment by severity: Step 1; mild, intermittent :  Asthma treatment by severity: Step 1; mild, intermittent No daily preventive meds needed: treat symptoms only. Treatment should be required no more than 2/week. Short acting beta-2 agonist: Albuterol MDI with face mask or spacer. Cost: $30-50/ canister. Step one::  Step one: One inhaler... Asthma treatment by severity: Step 2; mild, persistent:  Asthma treatment by severity: Step 2; mild, persistent Days with symptoms >2 times per week Nights with symptoms: >2 per month but less than 5 times/month. percent predicted PEF >80%. Asthma treatment by severity: Step 2; mild, persistent:  Asthma treatment by severity: Step 2; mild, persistent Daily anti-inflammatory medications: Cromolyn (Intal) inhaler $47.00 Nedocromil (Tilade) inhaler $36.00 or Low- to medium dose inhaled corticosteroid [range of prices: Budesonide (Pulmicort Turbuhaler DPI), 200 µg per puff $19.00 to Fluticasone (Flovent), 44 µg per puff $47.00 (13-g canister)] Asthma treatment by severity: Step 2; mild, persistent:  Asthma treatment by severity: Step 2; mild, persistent Short-acting bronchodilator as needed for symptoms. Intensity of treatment depends on severity of exacerbation: Inhaled short-acting beta2 agonist by nebulizer or spacer/holding chamber and face mask or Oral beta2 agonist. Step two::  Step two: Two inhalers... Treatment of Asthma by severity: Moderate Persistent Asthma (Step 3):  Treatment of Asthma by severity: Moderate Persistent Asthma (Step 3) Day time symptoms:Daily Night time symptoms>5 times per month PEF >60 to <80% Treatment of Asthma by severity: Moderate Persistent Asthma (Step 3):  Treatment of Asthma by severity: Moderate Persistent Asthma (Step 3) High dose corticosteroid inhaler daily. Long acting daily bronchodilators. Short acting bronchodilator for symptoms. Step 3::  Step 3: Rx with…? Step 3::  Step 3: 3 inhalers... High dose corticosteroid inhaler daily.:  High dose corticosteroid inhaler daily. Beclomethasone (Vanceril DS MDI), 84 µg per puff $42.00 Fluticasone (Flovent 220 µg per puff $95.50 Reduce to lower dose once symptoms controlled. Long acting daily bronchodilators.:  Long acting daily bronchodilators. Salmeterol (Serevent MDI) $42.00 (Serevent Diskus DPI) $43.50 Short acting bronchodilators for rescue only: Albuterol. Step 4: Severe and persistent Sx:  Step 4: Severe and persistent Sx Days with symptoms: Continual nights with symptoms: Frequent PEF <60% predicted. Usually add oral pred to Step 3 medications.:  Usually add oral pred to Step 3 medications. Treatment can be variable in step 4. Step 4; severe, persistent :  Step 4; severe, persistent Daily anti-inflammatory medications: High-dose inhaled corticosteroid with spacer/ holding chamber and face mask and If needed, add systemic corticosteroids (0.25 to 2 mg per kg per day) and reduce to lowest daily or alternate-day dosage that stabilizes symptoms. What is the role of Antileukotrienes ? :  What is the role of Antileukotrienes ? “In patients with chronic asthma who are symptomatic while receiving moderate-to-high doses of inhaled beclomethasone, the addition of 2 to 4 times the licensed dose of antileukotriene (AL) agents reduces the rate of exacerbations that require systemic corticosteroids. Insufficient evidence exists that AL confers benefit over doubling the dose of corticosteroids or that it has an inhaled corticosteroid-sparing effect.” Cochrane Database Syst Rev. 2002;(1):CD003133 What is the role of Antileukotrienes ? :  What is the role of Antileukotrienes ? They are new drugs, and expensive. The doses that seem to work are higher than marketed recommendations. They may help in Step 3 and 4, to reduce exacerbations, and reduce need to increase dose of inhaled steroids. No worrisome side effects…yet. Home severity monitoring may help keep kids out of the hospital.:  Home severity monitoring may help keep kids out of the hospital. First, determine their “Personal Best” Ask them to check PF a few times each day, for two weeks, when asthma in good control. Write out the PF Color Zones:  Write out the PF Color Zones PF <50% Red Zone PF 50-80% Yellow Zone PF> 80%: Green Zone Green Zone: PF > 80% of personal best.:  Green Zone: PF > 80% of personal best. No symptoms at all. Good Control. Continue taking regular medications. Yellow Zone: PF 50%-80%:  Yellow Zone: PF 50%-80% CAUTION! Need rescue meds: Use short acting Beta-2 agonist (Albuterol MDI or nebulizer). Consider increasing dose of medication. Monitor PF more frequently. Red Zone: PF < 50%:  Red Zone: PF < 50% Use Short Acting beta-2 Agonist: Albuterol. Call doctor’s office, or seek medical attention. Kids die of Asthma.:  Kids die of Asthma. Mortality rate increasing. Who is at risk of dying of asthma?:  Who is at risk of dying of asthma? Severe disease: 1-2% of these kids will die of asthma. Hx: prior hospitalization, steroid need. Symptoms triggered by foods. Self weaning, esp. off steroids. Lack of parental care. Poor, African-American, boys. However…in large study of asthma deaths::  However…in large study of asthma deaths: 33% had mild asthma. 34% had no prior hospitalization. A minority of patients (15-30%) die suddenly, within two hours of onset of dyspnea. When assessing a sick asthmatic::  When assessing a sick asthmatic: If they are unable to lie down, the severity is moderate of great, and they will need more aggressive work up and treatment. The end.:  The end.

Related presentations


Other presentations created by Sigfrid

Diabetes Mellitus
29. 02. 2008
0 views

Diabetes Mellitus

bus108 pp 08spr
08. 05. 2008
0 views

bus108 pp 08spr

Ch01
07. 05. 2008
0 views

Ch01

Steenburgh
02. 05. 2008
0 views

Steenburgh

107249 firstfileFILE
02. 05. 2008
0 views

107249 firstfileFILE

Regional Roadshows generic
30. 04. 2008
0 views

Regional Roadshows generic

PE3 U2 R
24. 04. 2008
0 views

PE3 U2 R

Hydrogen Workshop
22. 04. 2008
0 views

Hydrogen Workshop

GW052307MS3Rv3Final
21. 04. 2008
0 views

GW052307MS3Rv3Final

0329
18. 04. 2008
0 views

0329

3 Johnson BMGs
10. 01. 2008
0 views

3 Johnson BMGs

Packaging
10. 01. 2008
0 views

Packaging

HIV AIDS PM
12. 01. 2008
0 views

HIV AIDS PM

PM Insv01
12. 01. 2008
0 views

PM Insv01

ISECON 2006 Sharp
13. 01. 2008
0 views

ISECON 2006 Sharp

Panda life
15. 01. 2008
0 views

Panda life

Extinction
15. 01. 2008
0 views

Extinction

Empirical Formula
16. 01. 2008
0 views

Empirical Formula

Earth Resources
16. 01. 2008
0 views

Earth Resources

religion 1
17. 01. 2008
0 views

religion 1

020607 AmbassadorBriefing
21. 01. 2008
0 views

020607 AmbassadorBriefing

Christmas Sing along
15. 01. 2008
0 views

Christmas Sing along

Courseintro
04. 02. 2008
0 views

Courseintro

FAQ Presentation
24. 01. 2008
0 views

FAQ Presentation

CMS update
12. 02. 2008
0 views

CMS update

Brian Steele
28. 01. 2008
0 views

Brian Steele

crypto f05 s2
29. 01. 2008
0 views

crypto f05 s2

writing varner
06. 02. 2008
0 views

writing varner

The Maya
07. 02. 2008
0 views

The Maya

Fichner Rathus CH12
12. 02. 2008
0 views

Fichner Rathus CH12

bristol
14. 02. 2008
0 views

bristol

pps 310
14. 02. 2008
0 views

pps 310

LCR02
15. 02. 2008
0 views

LCR02

burton RESTEasy
21. 02. 2008
0 views

burton RESTEasy

Glaucoma
25. 02. 2008
0 views

Glaucoma

festival on a budget
27. 02. 2008
0 views

festival on a budget

Projection Systems Ortho and Iso
09. 01. 2008
0 views

Projection Systems Ortho and Iso

Slide Presentation
28. 02. 2008
0 views

Slide Presentation

Age Of Enlightenment
03. 03. 2008
0 views

Age Of Enlightenment

JobPostings
11. 03. 2008
0 views

JobPostings

ESCI101 26 Groundwater1
12. 03. 2008
0 views

ESCI101 26 Groundwater1

79 3843 6 1950s Powerpoint
19. 03. 2008
0 views

79 3843 6 1950s Powerpoint

Operating Systems ofthe Home
10. 01. 2008
0 views

Operating Systems ofthe Home

climate transport brazil
25. 03. 2008
0 views

climate transport brazil

garetiree
07. 02. 2008
0 views

garetiree

LUENTO3Embryo development
10. 03. 2008
0 views

LUENTO3Embryo development

Woolly Monkey Research
31. 03. 2008
0 views

Woolly Monkey Research

nixonforeignpolicy JoshR BenK
03. 04. 2008
0 views

nixonforeignpolicy JoshR BenK

bahai
07. 04. 2008
0 views

bahai

Chapter 13 Global Clim
27. 03. 2008
0 views

Chapter 13 Global Clim

nach31d fuzeon vortr
28. 03. 2008
0 views

nach31d fuzeon vortr

d04 vp matousek
15. 04. 2008
0 views

d04 vp matousek

red binder pages
14. 04. 2008
0 views

red binder pages

KULDA Training 0405
23. 01. 2008
0 views

KULDA Training 0405

3 eReturn to work
29. 01. 2008
0 views

3 eReturn to work

slides trouble with tanning beds
04. 02. 2008
0 views

slides trouble with tanning beds

faith based focus group
13. 01. 2008
0 views

faith based focus group

pogorelova
14. 02. 2008
0 views

pogorelova

2 Trevor
16. 01. 2008
0 views

2 Trevor

goldstein 6th c7 editedW06
14. 01. 2008
0 views

goldstein 6th c7 editedW06

scenarios candice
28. 01. 2008
0 views

scenarios candice

histrespr2007
28. 01. 2008
0 views

histrespr2007

MontrealEngineering5 5 03
25. 01. 2008
0 views

MontrealEngineering5 5 03

ithaca presentation
17. 01. 2008
0 views

ithaca presentation

rapport medarbetarenkat 06
07. 02. 2008
0 views

rapport medarbetarenkat 06

2hmr theme1
15. 01. 2008
0 views

2hmr theme1

almy ieee
11. 01. 2008
0 views

almy ieee

DAMM Presentation Businet
13. 01. 2008
0 views

DAMM Presentation Businet

odrecva
05. 02. 2008
0 views

odrecva

Lecture4metabolism
23. 01. 2008
0 views

Lecture4metabolism

20060608 NAT2006
20. 02. 2008
0 views

20060608 NAT2006

Amarger Hitachi
08. 04. 2008
0 views

Amarger Hitachi

ERMSAR COMET S2 5
16. 01. 2008
0 views

ERMSAR COMET S2 5

Tim Riedel
24. 01. 2008
0 views

Tim Riedel

jmajor022206
11. 02. 2008
0 views

jmajor022206