Pediatric (Childhood) Asthma: Clinical Presentation

00:01 So if you are examining a child who you suspect have asthma, it’s important, first off, to note their overall appearance and whether they have respiratory distress.

00:12 In a child with asthma who is in respiratory distress, we are going to first address their respiratory distress and later ask the question about whether maybe this isn’t asthma or some other disease.

00:24 In other words, the typical paradigm you'll learn of what’s the differential diagnosis and now how do we manage the patient is put on hold in asthma because we may not have time to address their differential diagnosis.

00:38 First, we need to jump to what is what’s most concerning.

00:42 Because asthma represents by far and away the most common cause of wheeze in children, we’re going to just address their asthma first if they’re in grave respiratory distress and do studies later.

00:53 We’re going to check their respiratory rate and their lung exam.

00:56 Very important to know what is that sound Is there air entry throughout? Is there wheezing throughout? Is it inspiratory and expiratory wheezing? Do they have rhonchi, which might be bronchiolitis? Or do they have crackles, which might be pneumonia? This will help us distinguish these things.

01:14 It’s important to note their heart rate and their cardiac exam keeping in mind that albuterol, once it’s given, is absolutely going to cause tachycardia as a side effect of the drug.

01:26 But if they’re having a high heart rate, it may be because they’re afraid or they have air hunger, but it may also because they’re having problems with oxygenation.

01:36 It’s important to examine the liver in an asthmatic and that might not seem totally obvious right off the bat.

01:42 But remember, in asthma, the problem is getting the air out.

01:46 It’s obstructive lung disease.

01:48 These patients are hyperinflated and it would be very unusual to fail to appreciate a liver.

01:54 In other words, if you put your hands under the right lower -- right upper quadrant, you should feel a liver edge in an asthmatic who’s having an exacerbation.

02:03 So expect a little bit of a liver edge in these children.

02:08 It’s helpful to find allergic stigmata, things like hives or eczema or other findings in a patient with asthma.

02:18 If you see clubbing or failure to thrive, that is not asthma.

02:22 Something else is going on and you need to figure out what is the cause of this pulmonary situation.

02:30 So those are the key physical exam findings we’re going to look for.