October Week 4

1.  Asthma Epidemiology, Pathophysiology, and Initial Evaluation:   
           Pediatrics in Review 2009;30;331

2. Practical Management of Asthma: Pediatrics in Review 2009;30;375

REFERENCE ARTICLES: (if interested)
1. Tucson Children’s Respiratory Study: 1980 to present. J Allergy Clin 
            Immunol. 2003 Apr;111(4):661-75

2. Guidelines for the Diagnosis and Management of Asthma 
         Full Report 2007. 
           US Dept of Health and Human Services. 
           National Heart, Lung,and Blood Institute: 
           National Asthma Education and Prevention Program.

CASE 1: 
An 11-month old boy presents with a fever, rhinorrhea and wheezing for the past 2 days. On PE, he is mildly tachypneic and you auscultate diffuse wheezes bilaterally. He had a similar illness 2 months ago. Mom is concerned he may develop asthma. Based on your reading,

What anticipatory guidance can you give this mother regarding her son’s risk of developing asthma during his childhood? (Be specific)
What would you tell this mother about her older son’s risk of developing asthma. He is a 6 year old “wheezer” with a history of eczema and allergic rhinitis?
In an effort to sound smart, you start to explain to the GT3 in clinic the pathophysiology behind asthma and you say…_________. In your discussion, you include early and late phase responses and the role of IgE.
Mom tells you her friend’s son had some testing done for asthma. A PFT? She wants to know if her children needs to be tested. What do you tell Mom about both children? (Be specfic)


A 10 year old asthmatic presents to your office with a 2 month history of persistent cough and shortness of breath.

What historical information do you need to classify his asthma severity? Discuss the role of age in assigning a severity category, in addition to major and minor risk factors for asthma.
 He tells you his symptoms are daily and he wakes at least 3-4 nights per week with symptoms. His symptoms are also much worse when playing basketball. How would you classify the severity of his asthma and accordingly, what value would you anticipate for his FEV?
You review his chart and see that he is currently prescribed albuterol PRN and a low-dose inhaled corticosteroid. What are your thoughts on his current treatment regimen? What is your plan of care for today’s visit?
Again, you want to impress the GT3s in clinic, so you reach deep into your memory banks and start to explain the pharmacology/pharmacokinetics of short and long term asthma medications, including SABAs, anticholinergic medications, systemic corticosteroids. inhaled corticosteroids, cromolyn sodium, leukotriene inhibitors, LABAs, and omalizumab.
BONUS QUESTION: If you are feeling particularly energetic today, go ahead and discuss delivery devices for asthma medications. A nebulizer is more effective than a MDI, isn’t it?