Pediatric Reactive Airway Disease Workup

  • Author: Eric S Chin, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Dec 1, 2011
 

Laboratory Studies

A complete blood count (CBC) may be indicated for a suspected viral infection (lymphocytosis, leukopenia), parasitic infection (eosinophilia), or hemosiderosis.

An arterial blood gas (ABG) determination should be performed for any patient in status asthmaticus to check for hypoxia, hypercarbia, or acidosis; alternatively, a venous blood gas measurement can be used to assess for hypercarbia and acidosis and combined with pulse oximetry monitoring.

An assessment of electrolyte levels may reveal hypokalemia in patients who are using albuterol.

Although theophylline is prescribed less frequently, a theophylline level is useful for those on the drug.

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Imaging Studies

Routine radiography does not need to be part of the initial routine workup of asthma.[11]

Consider chest radiography if increased temperature, absence of family history of asthma, and the presence of localized wheezes or rales.

  • Hyperinflation
  • Peribronchial thickening
  • Atelectasis
  • Radiographs may provide evidence of foreign body, associated vascular anomalies, cardiac enlargement, pulmonary hypertension, infiltrates, or masses.
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Other Tests

  • All chronically wheezing infants and children with chronic asthma should have a sweat chloride test for cystic fibrosis at a subsequent primary care provider (PCP) visit or during inpatient evaluation.
  • A tuberculosis skin test may be indicated if significant risk factors exist.
  • Allergy testing
  • Exercise tolerance testing
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Procedures

Procedures include the following:

  • Spirometry (decreased forced expiratory volume in one second [FEV1])
    • Bedside spirometry is the primary procedure for children with RAD who are older than 5 years.
    • Patients with decreased FEV1 require further evaluation and treatment.
  • A barium swallow may be indicated to determine any esophageal, pulmonary, or vascular pathology, particularly a tracheoesophageal fistula.
  • Bronchoscopy (rarely indicated) (see Table 1 below)
  • Peak expiratory flow (PEF) is the most common form of pulmonary function test monitoring. Record the best of 3 attempts. Possible life-threatening asthma exacerbation with PEF predicted of less than 30%; severe exacerbation, with less than 50%; and moderate exacerbation, with less than 80%.

Peak flow rates are described in the table below.

Table 1. Peak Flow Rates in Liters per Minute[12] (Open Table in a new window)

Height in



Inches



Average



Rate



Range*Height in



Inches



Average



Rate



Range*
40150110-19056330240-420
41160115-20557340240-420
42170120-22058360260-460
43180130-22059375270-480
44190135-24560390280-500
45200145-25561400290-510
46210150-27062415300-530
47220160-28063430310-550
48230165-29564445320-570
49240175-30565460330-590
50250180-32066480345-615
51260190-33067500360-640
52270195-34568515370-660
53280200-36069530380-680
54300215-38570550395-705
55315225-40571570410-730
*Includes 95% of white males aged 7-20 years.



Derived and adapted from J Pediatr 1979;95:192-6.



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Contributor Information and Disclosures
Author

Eric S Chin, MD  Consulting Staff, Department of Emergency Medicine, Kaiser Permanente Hospital, South San Francisco

Disclosure: Nothing to disclose.

Specialty Editor Board

Debra Slapper, MD  Consulting Staff, Department of Emergency Medicine, St Anthony's Hospital

Debra Slapper, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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Patient peak flow record.
This nomogram results from tests carried out by S. Godfrey, MD, and his colleagues on a sample of 382 healthy boys and girls aged 5-18 years. Each child blew 5 times into a standard Wright Peak Flow Meter, and the highest reading was accepted in each case. All measurements were completed within a 6-week period. The outer lines of the graph indicated that the results of 95% of the children fell within these boundaries.
Stepwise approach for managing asthma in children 0 to 4 years of age. National Institutes of Health. National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. August 2007. NIH publication no. 07-4051. Available at: http://www.nhlbi.nih.gov/guidelines/asthma/index.htm. 3 Accessed December 30, 2007. PRN, As necessary.
Table 1. Peak Flow Rates in Liters per Minute[12]
Height in



Inches



Average



Rate



Range*Height in



Inches



Average



Rate



Range*
40150110-19056330240-420
41160115-20557340240-420
42170120-22058360260-460
43180130-22059375270-480
44190135-24560390280-500
45200145-25561400290-510
46210150-27062415300-530
47220160-28063430310-550
48230165-29564445320-570
49240175-30565460330-590
50250180-32066480345-615
51260190-33067500360-640
52270195-34568515370-660
53280200-36069530380-680
54300215-38570550395-705
55315225-40571570410-730
*Includes 95% of white males aged 7-20 years.



Derived and adapted from J Pediatr 1979;95:192-6.



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