Pediatric Asthma
OS 213: Pulmunology
Maria Liza B. Zabala, M.D.Exam 1
Dec 11, 2008 | Thursday
Page 3 of 8SexyBacks
30% < 1 year
80-90% before 4-5 years old
Before puberty: asthma occurs 11/2-3x male >female
Adolescence male=femalePredisposing Factors involved in the Development of Asthma
Atopy
defined as the preponderance toproduce abnormal amounts of IgE inresponse to environmental allergens
Familial association among asthma,allergic rhinitis and atopic dermatitissuggests a common genetic basis-chromosomes 5, 11
90% of asthmatic children have anallergic component
64-84% (+) family history of asthmaamong 1st degree relatives
30% & 3.5% of asthmatic patientsreported asthma in one parent and innone respectively
Gender
Male preponderanceTriggers
Risk factors that cause asthma exacerbation byinducing inflammation or provoking acutebronchoconstriction or bothTrigger Factors of Asthma in Various Age GroupsAnatomic and physiologic peculiarities that predispose toobstructive airway disease1.Decreased amount of smooth muscle inperipheral airways2.Mucosal gland hyperplasia in the major bronchicompared to adults favors increased intraluminalmucus production3.Disproportionately narrow peripheral airways upto 5 years of age4.Decreased static elastic recoil of the young lungpredisposes to early airway closure during tidalbreathing5.Highly compliant rib cage and mechanicallydisadvantageous angle of insertion of diaphragmto ribcage increases diaphragmatic work of breathing6.Decreased number of fatigue-resistant skeletalmuscles in the diaphragm7.Deficient collateral ventilation with the pores of Kohn and the Lambert canals deficient in number and sizeMasqueraders of asthma in children
Upper airway noise/congestion
Cystic fibrosis (CF)
Gastroesophageal reflux disease (GERD)
Bronchopulmonary dysplasia (BPD)
Foreign body aspiration
Immunodeficiency (ID)
Vocal cord dysfunction
CLINICAL FEATURES
Frequent episodes of wheeze (more than once amonth)
Activity induced cough or wheeze
Nocturnal coughs in periods without viralinfections
Absence of seasonal variations in wheeze
Symptoms that persist after the age of 3
Wheeze before the age of 3 and one major riskfactor
parental history of asthma or eczema or two or three risk factors (eosinophilia,wheezing without colds, and allergicrhinitis) has been shown to predict thepresence of asthma in later childhood
DIAGNOSIS
Signs and symptoms to look for include:
Frequent coughing spells, which may occur during play, at night, or while laughing. It isimportant to know that cough may be the onlysymptom present.
Less energy during play
Rapid breathing
Complaint of chest tightness or chest "hurting”
Whistling sound (wheezing) when breathing inor out
See-saw motions (retractions) in the chestfrom labored breathing
Shortness of breath, loss of breath
Tightened neck and chest muscles
Feelings of weakness or tirednessSpirometry
Recommended in the initial assessment of patients suspected to have asthma
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