Snapshot A 5-year-old is brought to his pediatrician’s office by his parents because he cannot keep up with his friends while playing outside because he is short of breath. His parents report that they notice him occasionally coughing at night but he is otherwise healthy. On physical exam, respiratory rate is within normal limits and slight end expiratory wheezing is appreciated diffusely. Introduction Clinical definition login to view 1 more bullet Epidemiology Can present at any age Most common chronic pediatric disease Risk factors login to view 9 more bullets ETIOLOGY Pathogenesis login to view 8 more bullets CLASSIFICATION Classification based on daytime and nighttime symptoms Asthma Classification Severity Symptom Frequency Pulmonary Function Test Intermittent ≤2 days/week ≤2 nights/month FEV1 > 80% of predicted Mild persistent > 2/week but < 1/day > 2 nights/month FEV1 ≥ 80% of predicted Moderate persistent Daily daytime > 1 night/week FEV1 60-80% of predicted Severe persistent Continual daytime Frequent nighttime FEV1 < 60% of predicted Presentation Symptoms login to view 5 more bullets Physical exam login to view 12 more bullets Special presentations login to view 6 more bullets imaging Chest radiograph login to view 2 more bullets studies pulmonary function tests login to view 1 more bullet peak expiratory flow rate login to view 2 more bullets arterial blood gas login to view 4 more bullets diffusing capacity of carbon monoxide login to view 1 more bullet Differential Anaphylaxis login to view 2 more bullets Foreign object lodged in the respiratory tract login to view 2 more bullets Post nasal drip login to view 3 more bullets Congestive heart failure login to view 2 more bullets Gastroesophageal reflux disease login to view 2 more bullets DIAGNOSIS Diagnostic testing login to view 5 more bullets Diagnostic criteria login to view 8 more bullets Treatment of Acute Exacerbations Management approach login to view 4 more bullets Medical login to view 11 more bullets Interventional login to view 9 more bullets Treatment of Chronic Asthma Management approach login to view 2 more bullets Therapy based on the classification login to view 13 more bullets Other medical management strategies login to view 9 more bullets Lifestyle modifications including allergy avoidance Complications Acute respiratory failure Status asthmaticus Atelectasis Pneumothorax Use of non-specific β-blockers (i.e., blocking β2) can close airways leading to death