Term
| What are key aspects of the history in asthma? |
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Definition
-nature of symptoms
-pattern of symptoms
-profile of typical acute episode
-previous and current drug therapy
-triggers
-impact on child
-atopic history
-environmental history
-family history
-general medical history |
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Term
| What are key aspects of the physical exam in asthma? |
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Definition
-VS
-ENT: signs of upper airway obstruction, infection, allergy
-chest and lungs: observation, percussion, palpation, auscultation
-heart and abdomen
-digital clubbing |
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Term
| What is the differential diagnosis for wheezing? |
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Definition
-foreign body aspiration
-recurrent aspiration
-tracheomalacia
-vascular anomalies
-mediastinal masses
-COPDs
---bronchopulmonary dysplasia
---CF
-left ventricular failure
-vocal cord dysfunction |
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Term
| What is the clinical presentation of asthma? |
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Definition
-recurrent episodes of wheezing
-nighttime cough
-cough or wheeze after exercise
-cough, wheeze, or chest tightness after exposure to airborne allergens or pollutants
-recurrent colds or bronchitis |
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Term
| What is the general management of asthma? |
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Definition
-patient and parent education
-avoid asthma triggers
-recognition of symptoms
-proper use of medications |
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Term
| What is symptom management for intermittent asthma? |
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Definition
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Term
| What is the management when inhaled corticosteroid fails to control asthma? |
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Definition
-increase ICS
-add long-acting beta agonist
-add leukotriene modifier |
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Term
| What are management guidelines for initially establishing control of asthma? |
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Definition
-inhaled corticosteroids
-short course of oral corticosteroids
-scheduled use of short-acting bronchodilators
-PRN use of short-acting bronchodilators
-NOT LABA d/t side effects |
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Term
| What is the management of acute asthma exacerbations? |
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Definition
-inhaled beta2 agonist: relief of airflow obstruction
-systemic corticosteroids: suppress and reverse airway inflammation
-oxygen: relieve hypoxemia
-serial measurements of lung function: monitor response |
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Term
| Which asthma medications are bronchodilators? anti-inflammatory? |
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Definition
Bronchodilators
-beta 2 adrenergic receptor
-anti-cholinergics: ipratroprium bromide
-magnesium
Anti-inflammatory
-steroids |
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Term
| What is the etiology of vocal cord dysfunction? |
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Definition
-paradoxical closure of vocal cords on inspiration and/or expiration
-stridor, wheezing, shortness of breath |
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Term
| What is the epidemiology of vocal cord dysfunction? |
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Definition
-adolescents and young adults
-more common in females, especially overweight
-often coexists with asthma, psychiatric problems, abuse |
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Term
| What clinical presentation indicates vocal cord dysfunction instead of asthma? |
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Definition
-lack of response to asthma therapy
-lack of nighttime symptoms
-lack of consistency of symptoms when exposed to identical stimuli
-consistent history, laboratory data, pulmonary function testing |
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Term
| What is the differential diagnosis for vocal cord dysfunction with stridor? |
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Definition
-anaphylactic laryngeal edema or spasm
-angioneurotic edema
-laryngeal mass, cysts, webs, etc.
-vocal cord paralysis
-subglottic stenosis |
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Term
| What is the management for vocal cord dysfunction acute episodes? |
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Definition
-reassurance
-pant, cough
-oxygen
-heliox |
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Term
| What is the management for vocal cord dysfunction? |
|
Definition
-speech therapy
-biofeedback
-psychiatric
-encourage acceptance of diagnosis |
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Term
| What is included in the evaluation for vocal cord dysfunction? |
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Definition
-history and PE
-CXR: normal in VCD
-pulmonary function testing: flow volume loops
-exercise test for EIB
-laryngoscopy: paradoxical closure of vocal cords, while symptomatic |
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