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We retrospectively examined the medical records of all children between the ages of 2 and 18 yrs admitted to the pediatric ICU for treatment of status asthmaticus between April 1997 and June 2004. Children with chronic medical conditions other than asthma were excluded. Patients were identified from a previously existing database of ICU patients that is maintained by the Division of Critical Care for quality improvement purposes. Children were classified as normal weight 95% weight-for-age percentile ; or obese 95% weight-for-age percentile ; based on reference data collected by the National Center for Health Statistics 17 ; . We had planned to determine the body mass index BMI ; as a measure of obesity, but this was not calculated due to a lack of retrospective data regarding the height of the children involved in this study. Weight-for-age z scores were calculated using the CDC Epi Info software. Data were collected regarding basic demographics, indications for therapy, duration and level of therapy, duration of ICU and total hospitalization, and medications received. Length of stay was calculated from actual admission and discharge times. The Modified Pulmonary Index Score MPIS ; , a validated asthma severity score in.

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ASTHMA Adapted from Greg Matsuura, PharmD, BCPS Clinical Guidelines National Asthma Education and Prevention Program Expert Panel Report : nhlbi.nih.gov guidelines asthma index Measuring Lung Function Peak flow meters o Measure maximum forced expiratory flow rate with fully inflated lungs o Measures airway obstruction--not specific for asthma o Personal best Patient must be stabilized with consistent therapy Usually obtained in early afternoon Personal best estimated after peak expiratory flow rate recorded for 2-3 week period Reassess every 6 months in children because growth affects personal best o Monitoring with peak flow meters 80-100% of personal best Green Zone 50-79% of personal best Yellow Zone 50% of personal best Red Zone Use best reading after three tries Spirometry o Forced vital capacity FVC ; and forced expiratory volume in 1 second FEV1 ; o More consistent evaluation than peak expiratory flow rate o FEV1 FVC ratio 0.7 suggests expiratory disease Drug Therapy for Asthma Short-acting 2-agonists o Use: acute exacerbation, exercise-induced asthma, and temporary bronchoprotection o Potential Adverse Effects Tachycardia Headache Nervousness Arrhythmia Skeletal muscle tremor Hyperglycemia CNS stimulation Inhaled Short-Acting -agonists Generic Brand ; Dosage Forms Available Adult Dose children 12 ; Albuterol MDI: 90 mcg puff 2 puffs q4-6 hrs Proventil, Ventolin ; Nebulizer: 5 mg ml and 1.25-5 mg q4-8 hrs 2.5 mg 3ml solutions diluted ; Oral: 4mg tablet and 2mg 5ml oral syrup Levalbuterol Xopenex ; Bitolterol Tornalate ; Metaproterenol Alupent ; Isoetharine Bronchometer ; Pirbuterol Maxair ; Nebulizer: 0.63 mg 3ml and 1.25 mg 3ml solutions Nebulizer: 2 mg ml solution MDI: 370 mcg puff MDI: 650 mcg puff Nebulizer: 50 mg ml solution Nebulizer: 10 mg ml solution MDI: 200 mcg puff 2-4 mg dose 3-4 times day 0.63-2.5 mg q4-8 hrs 0.5-3.5 mg q4-8 hrs diluted; max 8mg day ; 2 puffs q4-6 hrs 2-3 puffs q3-4 hrs max 12 puffs day ; 0.2-0.3 ml q4-6 hrs diluted ; 4 inhalations diluted ; 2 puffs q4-6 hrs. Huitema ADR, Kerbusch T, Tibben MM, Rodenhuis S, Beijnen JH 2000 ; Reduction of cyclophosphamide bioactivation by thioTEPA: critical sequence-dependency in high-dose chemotherapy regimens. Cancer Chemother Pharmacol 46: 119-127.

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