October Week 4: Asthma

Wood P, et al. Practical Management of Asthma. Peds in Review. 2009;30;375-385
Hill V, et al. Asthma Epidemiology, Pathophysiology, and Initial Evaluation. Peds in Review. 2009;30;331-336.

Case 1:
A mother brings her 12 month old son to see you for fever for 2 days and “bad cough.” She notes he has been drinking well but his cough has been worsening, especially at night. On exam, the patient appears comfortable, but has mild subcostal retractions and inspiratory and expiratory wheezes throughout his lung fields. The patient’s uncle and cousin have asthma and mom wants to know what asthma is and if he son has it too.

How would you describe asthma to this mother? What do you tell her?
What is the differential diagnosis for wheezing?
Discuss the role of atopy and family history.
What are the risk factors for death in a child who has asthma?
What are common triggers?

Case 2:
You are seeing a 5 year old boy for a well visit. He has a h/o asthma and you ask dad about his asthma control. He reports, “he’s doing great. We use his albuterol nebs once or twice a week, but that’s just at night.” He hasn’t missed any school since he started kindergarten 3 months ago. On exam, he appears well and his lungs are clear.

How would you classify this child’s asthma?
Would you make any changes to his current regimen?
What else do you need to do for him before he leaves today?

Case 3:
A 13 yo girl comes to see you for a sick visit because her “asthma’s acting up.” She reports worsening cough, chest tightness, and is using her albuterol inhaler every few hours for the last 2 days. Before this, she reports needing albuterol a few times a week, and her last exacerbation was 1 year ago. On exam she has diffuse expiratory wheezing but with good air movement and no crackles. As you are finishing your exam, her parents walk in saying “sorry we weren’t here sooner – smoke break.” When you talk with them about it, you find they have both tried to quit but have been unsuccessful.

What changes will you make to her current regimen?
What else will you address before she leaves today?