Asthma

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)

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