The,Peak,Flow,Meter,and,the,Ac health The Peak Flow Meter and the Acute Attack
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Once the patient has obtained a "personal best value", changes in this "normal"reading can be used to direct therapy. Changes in peak flow of 25 percent, 50 percent, and 75 percent are useful guidelines for assessing the severity of an attack and how the patient should respond. Th avoid serious episodes, treatment should be initiated at the earliest indication of an attack (25 percent decrease in peak flow). Oral corticosteroids should be used for significant drops in flow (50 percent decrease). Emergency medical attention should be given for severe decreases (75 percent drop in peak flow). Childhood Asthma In evaluating the childhood asthmatic the physician must rely more on the patient's history and physical findings since measurements of pulmonary function may be difficult to obtain. This is particularly true for children under five years of age. Children older than five are generally able to provide peak flow measurements. The Medical History In the child's history the physician should look for evidence of cough and wheezing. Changes in a child's activity may reflect shortness of breath, especially if there is difficulty during exercise. Awakening at night may reflect nocturnal asthma. As in adults, the presence of nasal symptoms (drip, sneezing, congestion) may signal an allergy and increase the likelihood of asthma. A strong family history of allergy or asthma may help identify the childhood asthmatic. The Physical Examination The physical examination of an asthmatic child does not greatly differ from that performed on the adult. Once again, the presence of wheezing does not confirm the diagnosis. In a child there is a greater incidence of foreign body aspiration, which may produce wheezing and mimic asthma. Cystic fibrosis must be considered in a child with cough, sputum production, and wheezing. As in the adult patient, wheezing may be absent or intermittent. Asthma in Infants Asthma may occur in infants. More than half of childhood patients developed their first symptoms before age two. The most common source of asthma in children six months of age or younger is viral infection. This is often viral bronchitis or pneumonia. Indications of asthma in this age group may be a change in the child's cry or ability to feed or suckle. Children breathe rapidly but an increase in this rate or change in skin color due to a lack of oxygen called cyanosis may be significant indicators of asthma. Since the physician is unable to rely on measurements of airflow to determine the severity of asthma in this young age group, measurement of blood oxygen is often necessary.
The,Peak,Flow,Meter,and,the,Ac