Week 2 Pediatric Illness-Asthma
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Renae posted Nov 3, 2022 8:53 PM
Asthma is the most common chronic disease in children in the United States (Sawicki et al., 2022a). Prevalence of asthma has decreased in the United States from 9.4 percent in 2010 to 7.5 percent in 2018 (Sawicki et al., 2022a). Before puberty, boys have a higher prevalence but after puberty this trend reverses (Sawicki et al., 2022a). Asthma is a chronic condition that results in airway inflammation, hyperresponsiveness, and remodeling (Maaks et al., 2020). Inflammation of the airway causes bronchoconstriction, edema, and mucous resulting in the clinical manifestations of wheezing, coughing, chest tightness, and shortness of breath (Maaks et al., 2020). Asthma is commonly triggered by allergies, exercise, and viral infections (Cash et al., 2021). When a cough is related to asthma, it is typically described as dry, occurs more frequently at night, and is triggered by things such as cold, exercise, laughing, or crying (Sawicki et al., 2022a).
Diagnosis of asthma begins with a good history that includes medical and family history, symptoms and patterns, risk factors, and symptom triggers (Sawicki et al., 2022a). Children with allergic rhinitis, atopic dermatitis, and food allergies are more likely to develop asthma (Sawicki et al., 2022a). Children that have parents with asthma are 2.6 to 5.2 times more likely to be diagnosed with asthma (Sawicki et al., 2022a). A physical exam during an asthma exacerbation will usually exhibit a prolonged expiratory phase, wheezing, tachypnea, accessory muscle use during breathing, and hypoxia (Sawicki et al., 2022a). Spirometry that shows reversibility with a bronchodilator helps to confirm the diagnosis of asthma (Sawicki et al., 2022a). Spirometry can be difficult in the pediatric population under 5 years and for this age group reversal of symptoms with albuterol can be diagnostic (Sawicki et al., 2022a).
Treatment of asthma is based on severity of symptoms which can be determined through assessment questionnaires such as the Asthma Control Questionnaire or the Pediatric Asthma Control Communication Instrument (Sawicki et al., 2022b). Avoiding triggers is the major non-pharmacologic measure recommended to prevent asthma exacerbations (Global Initiative for Asthma, 2022). If symptoms are intermittent, a rescue inhaler such as albuterol is appropriate for treatment (Global Initiative for Asthma, 2022). If symptoms are persistent, the patient should have a maintenance medication prescribed such as an inhaled corticosteroid like fluticasone (Global Initiative for Asthma, 2022).
Education is very important for asthma patients but especially in the pediatric population (Sawicki et al., 2022b). Proper technique with the use of inhalers is essential to ensure that the patient is receiving the medication (Global Initiative for Asthma, 2022). Patients should be educated to keep an asthma diary to monitor their symptoms (Cash et al., 2021). They should also be educated on the purpose of each medication and using a maintenance medication regularly even when not symptomatic (Global Initiative for Asthma, 2022). Regular follow up is necessary with these patients to monitor symptom severity and control of the condition (Global Initiative for Asthma, 2022). Regular follow up will determine if symptoms are controlled or if step-up therapy is necessary (Global Initiative for Asthma, 2022).
Cash, J. C., Glass, C. A., Mullen, J. (2021). Family practice guidelines (5th Ed.). Springer
Global Initiative for Asthma. (2022). Pocket guide for asthma management and prevention: A pocket guide for health professionals. Retrieved October 28, 2022, from https://ginasthma.org/pocket-guide-for-asthma-management-and-prevention/
Maaks, D. L. G., Starr, N. B., Brady, M. A., Gaylor, N. M., Driessnack, M., Duderstadt, K. G., & Dirks, M. (2020). Burns’ pediatric primary care. (7th ed.). Elsevier.
Sawicki, G., Haver, K., Wood, R. A., Redding, G., & TePas, E. (2022a). Asthma in children younger than 12 years: Initial evaluation and diagnosis. UpToDate. Retrieved October 28, 2022, from https://www/uptodate.com/contents/asthma-in-children-younger-than-12-years-initial-evaluation-and-diagnosis/
Sawicki, G., Haver, K., Wood, R. A., Redding, G., & TePas, E. (2022b). Asthma in children younger than 12 years: Overview of initiating therapy and monitoring control. UpToDate. Retrieved Octobaqwer 28, 2022, from https://www/uptodate.com/contents/asthma-in-children-younger-than-12-years-overview-of-initiating-therapy-and-monitoring-control/
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