OS 213: Pulmunology Maria Liza B. Zabala, M.D.

Pediatric Asthma Exam 1

Appendix:
1. LONG TERM MANAGEMENT OF ASTHMA:
Pharmacologic Approach

Action: Asthma classified based on severity

Action: Administer drug therapy

Dec 11, 2008 | Thursday Page 1 of 6

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Levels of Control
2. SEVERITY OF ASTHMA EXACERBATIONS
Clinical features

Objective measures

Acute asthma exacerbations: Immediate care

Good response
 Resolution of wheezing and shortness of
breath
 Return of PEFR to normal
 Presence of sustained effect of the B2
agonist for 4 hours
Acute asthma exacerbations: Advance care
Poor response
 Presence of persistent wheeze
 Progression of dyspnea
 Abnormal PEFR
 Unsustained response to B2 agonist
Hospitalization
The decision to hospitalize is based on several factors. The following features can serve as guides on whether the patient
requires hospitalization:
 severity of attack - severe exacerbation or impending respiratory failure
 persistent severe airflow obstruction (PEFR < 60%)
 history of severe exacerbations
 current use or recent withdrawal from systemic corticosteroids
 inadequacy of support and home conditions

Admission to ICU
 progressive worsening of asthma symptoms despite initial management
 presence of sensorial changes (drowsiness, confusion) or loss of consciousness
 signs of respiratory fatigue (e.g. declining respiratory rate)
 impending respiratory arrest (paO2 < 60 mmHg on
 supplemental oxygen, pCO2 > 45 mmHg)