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.

Imaging Studies

Routine radiography does not need to be part of the initial routine evaluation of asthma.^[15]

Consider chest radiography in the setting of increased temperature, absence of family history of asthma, and the presence of localized wheezes or rales. Radiographs may reveal the following:

Hyperinflation
Peribronchial thickening
Atelectasis
Evidence of foreign body, associated vascular anomalies, cardiac enlargement, pulmonary hypertension, infiltrates, or masses

Other Tests

Other tests that may be considered are as follows:

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

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^[16] (Open Table in a new window)

Height in Inches	Average Rate	Range*	Height in Inches	Average Rate	Range*
40	150	110-190	56	330	240-420
41	160	115-205	57	340	240-420
42	170	120-220	58	360	260-460
43	180	130-220	59	375	270-480
44	190	135-245	60	390	280-500
45	200	145-255	61	400	290-510
46	210	150-270	62	415	300-530
47	220	160-280	63	430	310-550
48	230	165-295	64	445	320-570
49	240	175-305	65	460	330-590
50	250	180-320	66	480	345-615
51	260	190-330	67	500	360-640
52	270	195-345	68	515	370-660
53	280	200-360	69	530	380-680
54	300	215-385	70	550	395-705
55	315	225-405	71	570	410-730
Includes 95% of white males aged 7-20 years. Derived and adapted from J Pediatr* 1979;95:192-6.

Treatment & Management

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Media Gallery

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.

of 3

Table 1. Peak Flow Rates in Liters per Minute^[16]

Table 1. Peak Flow Rates in Liters per Minute ^[16]

Height in Inches	Average Rate	Range*	Height in Inches	Average Rate	Range*
40	150	110-190	56	330	240-420
41	160	115-205	57	340	240-420
42	170	120-220	58	360	260-460
43	180	130-220	59	375	270-480
44	190	135-245	60	390	280-500
45	200	145-255	61	400	290-510
46	210	150-270	62	415	300-530
47	220	160-280	63	430	310-550
48	230	165-295	64	445	320-570
49	240	175-305	65	460	330-590
50	250	180-320	66	480	345-615
51	260	190-330	67	500	360-640
52	270	195-345	68	515	370-660
53	280	200-360	69	530	380-680
54	300	215-385	70	550	395-705
55	315	225-405	71	570	410-730
Includes 95% of white males aged 7-20 years. Derived and adapted from J Pediatr* 1979;95:192-6.

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Pediatric Reactive Airway Disease Workup

Laboratory Studies

Imaging Studies

Other Tests

Procedures

References

Tables

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