Project Description

EMU 365: Pediatric Asthma Pearls and Pitfalls

This EMU365 video features Dr. Sarah Reid, presenting common pitfalls made in pediatric asthma diagnosis and management in the ED. She explains the importance of risk stratification using the PRAM score, early diagnosis of preschool asthma and initiating maintenance inhaled corticosteroid therapy upon discharge. 

Pediatric Asthma Pitalls

Pitfall #1: Making the diagnosis of bronchiolitis instead of asthma

  • If age of child less than or ~12mo: likely bronchiolitis
  • If diagnosis is unclear in children ~12mo, or unsure if presenting as early asthma or late bronchiolitis, check for response to salbutamol. Bronchiolitis will not respond to salbutamol 

Pitfall #2: Not diagnosing asthma in preschoolers (1-5 years of age)

  • PFTs are difficult to perform in children <6 years old, there’s a huge burden of ED visit and admissions in this age group for asthma like symptoms
  • Wheezing in early life is associated with a 10% reduction in FEV1 by 6 years of age and irreversible airway remodelling
  • CPS 2015: Diagnosis of asthma in preschoolers = >2 episodes of wheezing/airflow obstruction + demonstrating reversibility with bronchodilators +/- corticosteroids

Pitfall #3: Not using the PRAM score

  • Score stratifies severity and guides management
    • Mild 0-4: salbutamol
    • Moderate 5-8: plus steroids and ipratropium bromide
    • Severe 8-12: consider Mg
  • 5 clinical criteria: Tracheal tug, scalene muscle use, air entry, wheeze and O2 sat

Pitfall #4: Waiting to give corticosteroids

  • PRAM scores of moderate to severe – give systemic corticosteroids steroids as soon as possible
  • Systemic corticosteroids given in the first hr decreases length of stay and admission
  • Dexamethasone 0.6mg/kg (Max 12mg) for 2 days

Pitfall #5: Not giving controller medications when child goes home

  • Need inhaled corticosteroids (ICS) for a therapeutic trial at the time of discharge to prevent chronic symptoms in moderate to severe PRAM scores
  • Prescribe ICS for 3mo at the time of discharge, it takes 1-4 weeks to start working, reinforce daily use, cannot be on a PRN basis

 

Author Biography
Dr. Sarah Reid completed her medical degree from the University of Ottawa in 1999, followed by a Pediatric Residency and Pediatric Emergency Medicine (PEM) Fellowship at the Children’s Hospital of Eastern Ontario (CHEO).  She is an Assistant Professor in the Departments of Pediatrics and Emergency Medicine at the University of Ottawa, and a Clinical Investigator at the CHEO Research Institute. Her main academic interest lies in improving the care of children seen in general emergency departments across Canada.  As such, she is Co-Lead of the CHEO Emergency Department Outreach Program, Ontario Region Nodal Leader for Translating Emergency Knowledge for Kids (TREKK, www.trekk.ca) and PEM Educator for the Canadian Association of Emergency Physicians (CAEP) Emergency Medicine Review Course.  She is involved in a number of research projects dealing with pediatric concussion and mental health care and serves on the Emergency Medicine Examination Board for the Royal College of Physicians and Surgeons of Canada.

All EMU 365 Videos

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