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Management of Childhood Bronchial Asthma
TU Sukumaran
CHAPTER 1:
Diagnosis of Childhood Bronchial Asthma
Introduction
Asthma is characterized by three features
Mechanism of Bronchial obstruction in Bronchial Asthma (Fig. 1.1)
Bronchoscopic Appearance of Bronchus (Fig. 1.2)
Prevalence of Bronchial Asthma (Fig. 1.3)
Diagnosis
History
Investigations
Peak Expiratory Flow Rate (PEFR)
Typical Peak Flow Graph of an Asthmatic (Fig. 1.5)
Uses of PEFR Recording in Asthma
Spirometry (Fig. 1.6)
Differential diagnosis
CHAPTER 2:
Pathophysiology of Bronchial Asthma
CHAPTER 3:
Pharmacotherapy of Bronchial Asthma
CHAPTER 4:
Aerosol Therapy of Bronchial Asthma
Aerosol
Aerosol Deposition
Aerosol Delivery System
Pressurized Metered Dose Inhalers (PMDI) (Fig. 4.1)
Advantages of Mdi
Disadvantages
Accessory Devices: spacer/Valve Holding Chamber
Spacer with MDI and Baby Mask (Fig. 4.2 and 4.3)
Dry Powder Inhalers (Fig. 4.5)
Advantage
Disadvantage
Nebulizers
Advantage
Disadvantage
Ultrasonic Nebulizers
Small Particle Aerosol Generator (SPAG)
Aerosol Therapy in Infants
Aerosolized Drugs in Pediatric Asthma, Inhaled Corticosteroids (ICS)
Dosages of ICS
Precautions
Relievers
Anticholinergics
Aerosol Therapy in Asthma Situations
Aerosol Therapy in Non-asthmatic Situations
CHAPTER 5:
Management of Acute Bronchial Asthma
Incidence, Prevalence, and Definitions
Distinguish exacerbations from poor asthma control
Pathophysiology
Initial Assessment of Acute Asthma
Classification of Severity
Management of Acute Asthma
Oxygen
Hydration
Drugs used in management
Short-acting beta-2 agonists (SA beta-2 agonists):
Intravenous Bronchodilators
Corticosteroids
Ipratropium Bromide
Magnesium Sulfate (Table 5.11)
Intravenous Aminophylline
Management in Children under 2 years
Intensive Care Management
Noninvasive Positive Pressure ventilation
Indications for Intubation
Absolute Indications
Relative Indications
Intubation
Drugs used during intubation
Ventilation
Suggested Settings
Low Positive End Expiratory Pressure (PEEP)
Criteria for Weaning
Other Therapies
LTRAs in acute asthma
Heliox
Bronchoscopy and Bronchial Lavage
Extracorporeal Life Support
Practices not routinely followed
Antibiotics
Mucolytics
Sedatives
Chest physiotherapy
Hospitalization and Discharge Issues
Summary (Figs 5.2 and 5.3)
CHAPTER 6:
Management of Persistent Bronchial Asthma
Prevalence of Bronchial Asthma
Classification of Persistent Bronchial Asthma
Aims of Treatment
Controllers of Persistent Asthma
Inhaled Steroids: the First Line Treatment
Inhaled Steroids: Treatment Strategies (Tables 6.1 to 6.3)
Prognosis of Persistent Bronchial Asthma (Tables 6.4 to 6.6)
CHAPTER 7:
Wheezing in Children
Causes of Recurrent or Persistent Wheezing in Children
Principal Causes of Wheezing
Clinical Approach to a Child with Persistent Wheezing (Tables 7.2 and 7.3)
Physical Examination
Investigations (Figs 7.1 to 7.5):
Treatment
Prognosis
CHAPTER 8:
Under Five Wheeze
What Causes Wheezing in Under Five Children?
Asthma Predictive Index
Atypical wheezers (Figs 8.2 and 8.3):
Cystic adenomatoid malformation of lung (Figs 8.4 and 8.5):
Management of Asthma and Wheezing in an Under Five Child
Episodic Viral Wheezers
Multitrigger Wheezers
CHAPTER 9:
Asthma and Allergic Rhinosinusitis in Children
Epidemiology of Allergic Rhinitis in India
Clinical Features
Nasal Examination
Allergic Gape (Fig. 9.4)
Allergic Line (Fig. 9.5)
Allergic Mannerism (Figs 9.6 and 9.7)
Allergic Rhinitis and its Impact on Asthma (ARIA) classification (Flowchart 9.1):
Coexistence of Rhinitis and Asthma in Children
Effect of Sinusitis in Patients with Allergic Rhinitis and/or Asthma
Skin Test Reactivity in Allergic Rhinitis in India
Management
Pharmacotherapy
Treatment of Allergic Rhinitis (ARIA Guidelines)3 (Flowchart 9.2)
Indications for Immunotherapy
CHAPTER 10:
International Consensus on (ICON) Pediatric Asthma
Methodology
Asthma Definition
Classification
Research Recommendations
Pathogenesis and Pathophysiology
Natural History
Diagnosis
Diagnosis of asthma
Pediatric Asthma Differential Diagnosis
Evaluation of Lung Function
Asthma Control (Table10.1)
Four Basic Steps in Asthma Management
Asthma Management
Trigger avoidance
Pharmacotherapy
Medication for Acute Relief of Symptoms
Medications KUsed for Long-term Asthma Control
Inhaled Corticosteroids (ICS)
Leukotriene Receptor Antagonists (LTRA)
Long-acting Beta-2 Adrenergic Agonists (LABA)
Chromones
Omalizumab
Steps of Controller Therapy
Immunotherapy
Asthma Exacerbation
CHAPTER 11:
Patients and Parents Education on Bronchial Asthma
Introduction
What is Patient Education?
Why Education is Important in Management of Asthma?
Make Them to Accept the Diagnosis
What is Asthma?
What Causes Asthma?
Who Gets Asthma/Why my Child Got Asthma?
Is There any Difference between Allergy and Asthma/are these Terms Same?
Understand Trigger Factors and Avoid Them
Avoidable Trigger Factors
Drug Therapy
Likely Prognosis in Individual Cases
Adjuvant Therapy
Psychosocial Aspects
CHAPTER 12:
Prognosis of Childhood Bronchial Asthma
Family History of Atopy
Coexistence of Atopic Disease
Effect of Sex
Bronchiolitis in Infancy
Parental Smoking
Birth Weight and Prematurity
Age at Presentation
Severity and Frequency of Episodes
Lung Function Measurements
Annexure
INDEX
TOC
Index
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