2. Childhood Asthma A triad of atopic eczema, allergic rhinitis and asthma is called atopy.[53] The strongest risk factor for developing asthma is a history of atopic disease Most common chronic disease of childhood Begins under 5 years 300 million worldwide, 5 million children in US = 3-7 % 250K deaths annually Miss 3 X days school

3. Acute Exacerbations Outpatient Management How sick? Drugs? Doses? Defer Follow up

4. History & Physical Time onset Meds used Last β-agonist use High risk factors for severity Exam: VS / O2 sat / mental status / Respirations: Wheeze/accessory muscles/stridor/retractions

5. PSI Score: 0-15 7-11 Moderate > 12 Severe

6. Assessment Initial evaluation Respiratory treatment Refer for admission?

7. Tools PSI PERF (peek expiratory flow rate ) Hard if less than 6 years 3 tries standing Previous “best” most helpful CXR: usual trigger viral, low yield unless focal findings such as rales or decreased BS, >39° ABGs – rarely needed acutely, O2%sat good

9. Goals of Treatment Reverse airway obstruction Correct hypoxemia Reduce recurrences by intensifying baseline treatment

10. Specific Treatment Keep O2 > 92 % Frequent monitoring patient status

11. Outpatient Treatment of Mild Exacerbations Moderate and severe best treated in ED Mild PSI < 7 Beta agonist first line Corticosteroids in unresponsive to β agonist treatment Can add ipratropium to nebulizer treatments