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most obvious symptom, some patients may primarily have cough without significant wheeze Asking the family about typical symptoms for the child can provide clarification Asthma is generally a clinical diagnosis, and some clinicians hesitate to diagnose asthma in children younger than 24 months However, an asthma diagnosis is appropriate if the child has compatible history suggesting the characteristic features of lower airway obstruction, bronchial hyperresponsiveness, and reversible bronchospasm Airway inflammation levels and formal pulmonary function testing are uncommonly measured in the acute setting The prevalence of “lifetime” asthma (ever diagnosed) is estimated at 13% for U.S children, with 6.1 million having active disease, and 53% having ≥1 exacerbation per year according to 2016 data Children younger than years old have the highest rates of ED visits, ambulatory visits, and hospitalizations Asthma disproportionately affects minority children, those living in urban areas, and those of lower socioeconomic status Triage Prompt determination of the severity of respiratory distress will help direct appropriate therapy Level of severity can be generally categorized as mild, moderate, severe, or impending respiratory failure There are several validated severity scoring tools, including the Pediatric Asthma Severity Score, Modified Pulmonary Index, and Pulmonary Score Many clinical guidelines utilize such scores to outline severity-based therapy These scores also allow physicians and nurses to communicate about severity and response to therapy using a standard language Initial Assessment/H&P In addition to determining level of severity, obtaining asthma-specific history is helpful to inform emergent care and disposition Important history includes information about the current exacerbation (duration, course, home medications administered and response to treatment, and likely trigger) as well as chronic severity of asthma (number of exacerbations during prior 12 months, number of hospitalizations, number of ICU admissions, need for intubation, use of controller therapies) Chronic asthma severity reflects asthma control, often considered to include assessment of asthma risk (prior exacerbations requiring unscheduled visits, use of systemic corticosteroids, and hospitalizations) and impairment (asthma
Ngày đăng: 22/10/2022, 13:29
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