PEDIATRIC ASTHMA

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PEDIATRIC ASTHMA

• ??.????? ????????

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bronchiolitis
Asthma
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WHEEZING

• ?????????????????
• ????????????? wheezing ???????????????????????????
  ?? 1. ???????????? ?????? bronchopulmonary
  dysplasia, cystic fibrosis2. Gastroesophageal
  reflux disease (GERD)       GERD
  ??????????????????????????????????????????????????
  ???????????????????????????????? ???????????
  reflexive interaction ????????????????????????????
  ????????????????????????? ??????? ?????
  ?????????????????????????????? ???????????????????
  ?? ?????? obstructive apnea, reflux laryngitis,
  stridors ???? lower airway disease
  ????????????????? wheezing

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• 3. ??????????????????????????????????? ????
  tracheomalacia, vascular ring, bronchogenic cyst
  4. ??????????????????? ???????????????????????
  ?????? ???? ??????????????????????????
  ?????????????????????? mediastinal mass
• 5.wheezing syndrome ???????????????????
  wheezing associated respiratory tract infection
  (WARI)
• Bronchitis
• bronchiolitis
• asthma
• pneumonia       

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• ???????????????????????????????????????????
• ??????????????
• ??????????????????????????????????????
• 1. Airway inflammation
• 2. Increased airway responsiveness to a variety
  of stimuli
• 3. Reversible or partial reversible airway
  obstruction
• ???????????????????????? ????????
• ?????????????????????????
• ??????????????????????????????????????????????????
  ??????? ????????????????????????? (reversible
  airway obstruction)
• ?????????????????????? ???????????????????????????
  ??????????????????????? ?????????

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• ?????????????
• ?????????????????????????
• ??????????????????? ?????????????????
• ??????????????????????????????????????
• ????????????????????????????????????????????????
• ????????????????? ?????????? ???????????????????
  ??????????????????????????????????????
• ??????????????????????????????????????????????
  ?????????????????????????????????? (gt 10 ???)

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• ???????????????????????????????????????????????
• ?????? lt 5 ?? ?????????????????
  ??????????????? ??????????????????????????? BPD
  ???????
• ??????????????????? ???????????????????????????
• ????????????? ??????? ????? ??????????????????????
  ???????????????????? ???????
• ???????????????? ? ???????????????
  ?????????????? , ???????? , ?????????
• ????????????????????????????? ,
  ??????????????????? , ????????????? urticaria
  ??????? (????? Anaphylaxis)

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• ??????????????
• 1. ???????????????????????????????????????
  (wheeze) ????????????????????????????????????????
  ?????????? ? ???????????????????????????
  ????????????????????????????????????????????? ?
  ???? ????? ??? ????????????????
  ????????????? ?????????? ???????????????
• 2. ?????????????????????????
  ??????????????????????????????
• 3. ??????????????????????????????
• 4. ??????????????????????????????? ? ??????
  ???????? allergic rhinitis , allergic
  conjunctivitis ???? atopic dermatitis

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• ???????????????????????????????? lt 5 ??
• ???????????????????????????????
• ?????????????????? ? ( gt 1 ?????????????)
• ???????????????????? ??????????????
• ??????????????????????????????????????????????
• ???????????????????????? ? ??? ? ??????????

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• ?????????????????????????????????????????
• ????????????????????????? 3 ????? ??????????
  ???????????????????????????? ????????????????????
  ??? ???????
• ?????????????????????????????????????????
  (Atopic dermatitis) ???????????????????
  ?????????? ????
• ??????????????????? 2 ???????????
• ???????????????????? allergic rhinitis
• ????????????????????????????????????????????
• - ???? CBC ?? eosinophilia ( gt 4)

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Atopic dermatitis
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Atopic dermatitis
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Atopic dermatitis
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• ALLERGIC RHINITIS

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ALLERGIC RHINITIS
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• ?????????????????????? (Therapeutic trial)
  ?????????????????????? (?????????????? )
• ????????????????????????????????? short acting
  ß 2 - agonist ??? inhaled corticosteroids
  ?????????????????????????????????

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• ????????????????????????????????????
• 1.???????????????????????? (chest X-ray)
  ??????????????????????? ??????????????????????????
  ??????
• ???????????????????????????????????????????
• ?????????????????????????????????
• ??????????????????????????????? ????
  ???????????? ???? ?????? ???????
• ?????????????????????????????????????????
  ???? pneumothorax, atelectasis

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• 2. ???????????????????????????? (pulmonary
  function test)
• 2.1???????????????????????????????????????????
  ???????????????????????????????(reversible airway
  obstruction) ????????????????????????????????
  FEV1 (forced expiratory volume at 1 second)
  ???????????????? spirometer ??????? PEF (peak
  expiratory flow) ?????????????????? 15
  ??????????????????????????????????????
• 2.2 ?????????? peak flow variability
  (??????????) ????????????? peak flow meter
  ???????????????????????????????????? 20
  ???????????????????????????????

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• 3. ????????????????????????? ????
  ???????????????????????? (allergy skin prick
  test) ?????????????????????????????????????????
  (????????????? 70) ???????????? (atopic status)
  ???????? ??????????????????????????????????????
  ??????????????????????????? (?????????????????????
  ???????????????????????? ?) ??????????????????????
  ?????????? ???????????????????????????????????????
  ?????? ? ???????
• 4. ????????????????????????? methacholine ????
  histamine ?????????????????????

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• ?????????????????
• 1. ????????????????????????? ???? ???????
  ???????????? ????????? ?????? ???
• 2. ??????????????????????????????? ???? croup,
  foreign body, vascular ring ???
• 3. ??????????????????????????????? ???? BPD
  (bronchopulmonary dysplasia) ???
• ????????? ???? gastroesophageal reflux (GER),
  congestive heart failure ???

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????????
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• ???????????????????????????????
• 1.?????????????????? ?????????????????????
• 2.???????????????????????????????????
  ????????????????????
• 3.?????????????????????????????????????????????
• 4.????????????????????????????????
  ?????????????????????????????????
• 5.??????????????????????????
• 6.????????????????????????????

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• ???????????????????????????????
• ???????????????????????????????? 5 ?????????
• 1 ??????????????????????????????????
  ????????????????????????????????????????
• 2 ????????????????????????????????????????????????
  ????? ?
• 3 ????????????????????????????????????????????????
  ?????????????
• 4 ???????????????????????????????????????
• 5 ????????????????????????????????????

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• ?????????????????????????????
• ??????????????????????????????
• ???????????????????????????? ?????????????????????
  ?????? ???????????????????????????????????????????
  ?????????????????????????????????? asthma
  exacerbations ???????????????????????????????????
• ???????????????????????? asthma exacerbations
  ?????????? ??????????????????, ?????????
  ??????????????????????????? ???? FEV1, PEFR
  ??????????????

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• ???????????? asthma exacerbations ??????????
• - ?????? inhaled b2-agonist
• - ?????? systemic corticosteroids
  ??????????????? exacerbations ?????????
• - ????????????? ???? theophylline,
  anticholinergic drug ???
• - ?????? oxygen ?????????? exacerbations
  ?????????
• ?????????????????????????????????????????????????
  ?

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• Oxygen
• ??????????? oxygen ?????????? hypoxemia ???????
  FEV1 ???? PEFR lt 50 ??? predicted value,
  ????????????? SaO2 gt 95
• ??? oxygen ??? nasal cannula ???? face mask
• ????????????????????????? SaO2 ?????????? oxygen
  ??????
• ?????????????? (humidification) ????????
  ????????????????? water nebulizer

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• b2 - Agonists
• ???????? inhaled short-acting b2 - agonists
  ??????????????? ??????????????????????????????????
  ???????? 3 ???????????????????????????????????????
  ???????????????????????
• Nebulizers
• ??????????????? 3 doses ????????????????? 20 - 30
  ???? ???????????? ????????????????????????????????
  ?????????????????, ????????????????? airflow
  obstruction ??? wheezing ???/???? PEFR
  ???????????????????????

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• Metered-dose inhaler (MDI) with spacer
• ????? MDI with spacer ?????????????? (6-12 puffs)
  ????? bronchodilatation ????????????? nebulizers
  
• Injection
• ?????????????? severe bronchospasm
  ???????????????????????????????? ???????????
  terbutaline ???? salbutamol ????????????????
  (subcutaneous) ??????????????????? 0.01
  mg/kg/dose ?????????? 0.3 mg

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• ???????? lt 2 ?? ??? ?? ??? ???????????????????????
  ?????? ????????????????
• ??????????? ???????????? wheezing both lungs or
  generalized wheezing
• ??????????? Acute bronchiolitis
• ?????????????????? RSV
• ????????? bronchiolar obstruction/ swelling/
  edema
• ???????? ?????????/??????????? - salbutamol
  nebulized ?????? salbutamol ?????????????
  ???????????????
• Oxygen and hydration

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• ???????? gt 2 ?? ?? ??? ????????????????????
  ???????????????? ???????????????????
• ??????????? ???????????? wheezing both lungs or
  generalized wheezing
• ??????????? asthma / bronchial asthma
• ????????? bronchospasm
• ???????? ?????????/??????????? - salbutamol
  nebulized ?????? salbutamol ?????????????
  ???????????????????
• Nebulized ipratropium bromide

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• ???????? gt 2 ?? ?? ??? ????????????????????
  ???????????????? ???????????????????
• ??????????? ???????????? wheezing both lungs or
  generalized wheezing
• ??????????? asthma / bronchial asthma
• ????????? bronchospasm
• ???????? ?????????/??????????? - salbutamol
  nebulized ?????? salbutamol ??????????
  ???????????????
• systemic corticosteroid (oral prednisolone/IV
  hydrocortisone ???? dexamethasone)

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• ???????? gt 2 ?? ?? ??? ????????????????????
  ???????????????? ???????????????????
• ??????????? ???????????? wheezing both lungs or
  generalized wheezing
• ??????????? asthma / bronchial asthma
• ????????? bronchospasm
• ???????? ?????????/??????????? - salbutamol
  nebulized ?????? salbutamol ??? ??? systemic
  steroid ?????????????? ??????????????????????
• Inhaled corticosteroid

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