History
- Cough/Wheeze: onset, duration, timing (nocturnal – if at the beginning of the night then postnasal drip), prolonged with colds
- Triggers: exercise, cold air, illness/URTI, smoking, allergens, animals
- Allergy testing, Seasonal allergies, ASA allergy
- Pulmonary function testing (PFTs)
- Eczema, atopy, family history
- Medication attempts: what, length, frequency, result
- Environmental
- Pets (type, where, sleeping with child…)
- Smoking exposure
- Bedroom (bedding, carpets, closet, windows, dust)
- House (furniture, storage rooms, cleaning, toys, plants, furnace cleaning, humidifier)
- Location (farm, city), family/friends that are visited often
- Daycare, Sick contacts
- Function: school, activities
Physical Exam
- ABC’s
- Vitals
- Respiratory: Accessory muscle use, listen for wheeze
Acute exacerbation treatment
- Ventolin: 3 doses back to back (1.25 – 2.5 – 5mg)
- Atrovent 0.25mg
- Systemic steroids
- Pediapred 1mg/kg x 5 days then stop (2mg/kg if really bad)
- Methylpred IV
- Start on inhaled steroids while in hospital (at least 3 months, or until the end of winter)
* PFTs once well or close to well
* >3 yo Skin testing early as long as no benadryl w/i 24 hr
Note: Blood gas will show decreased K+ and respiratory alkalosis – a normal blood gas is BAD (tiring, can’t compensate so CO2 isn’t low as it should be).
Medications
- Bronchodilators: Ventolin
- Steroids: Pulmicort (neb or turbuhaler), Flovent (puffer), Qvar (puffer)
- Leukotriene antagonist: pill, assoc’d rhinitis
- Flonase/Nasonex (steroids for nose)