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OS 213: Pulmunology Maria Liza B. Zabala, M.D.

Pediatric Asthma Exam 1

Appendix:
1. LONG TERM MANAGEMENT OF ASTHMA:
Pharmacologic Approach
Action: Asthma classified based on severity

Action: Administer drug therapy

Levels of Control

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OS 213: Pulmunology Maria Liza B. Zabala, M.D.
Pediatric Asthma Exam 1

2. SEVERITY OF ASTHMA EXACERBATIONS


Clinical features

Objective measures

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OS 213: Pulmunology Maria Liza B. Zabala, M.D.
Pediatric Asthma Exam 1

Acute asthma exacerbations: Immediate care

Good response Poor response


• Resolution of wheezing and shortness of • Presence of persistent wheeze
breath • Progression of dyspnea
• Return of PEFR to normal • Abnormal PEFR
• Presence of sustained effect of the B2 • Unsustained response to B2 agonist
agonist for 4 hours

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OS 213: Pulmunology Maria Liza B. Zabala, M.D.
Pediatric Asthma Exam 1

Acute asthma exacerbations: Advance care

Hospitalization
The decision to hospitalize is based on several factors. The following features can serve as guides on whether the patient
requires hospitalization:
• severity of attack - severe exacerbation or impending respiratory failure
• persistent severe airflow obstruction (PEFR < 60%)
• history of severe exacerbations
• current use or recent withdrawal from systemic corticosteroids
• inadequacy of support and home conditions

Admission to ICU
• progressive worsening of asthma symptoms despite initial management
• presence of sensorial changes (drowsiness, confusion) or loss of consciousness
• signs of respiratory fatigue (e.g. declining respiratory rate)
• impending respiratory arrest (paO2 < 60 mmHg on
• supplemental oxygen, pCO2 > 45 mmHg)

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