Advancing Learners Pediatric Clinical Reasoning and Knowledge

Key Points

Wheezing does not mean someone has asthma.
Wheezing generally means that someone has bronchospasm which can occur once or twice at any age.

Asthma is a chronic condition where there is bronchospasm (i.e. spasms of the muscles that control the flow of air in the lung airways) and inflammation (of the lining of the airways). As it is a chronic condition, it has to occur more than once over time, with 3 times or more sometimes used as a functional definition.

Lung airways are like a balloon.
Bronchospasm and inflammation decrease the size of the airways just like stretching the top part of a balloon. When the balloon’s top is stretched, the balloon makes a wheezing sound. If stretched too tight, there actually is no sound as all the airflow is blocked. When medications are used, it is like the top of the balloon not being stretched. All the air escapes and the wheezing sound also stops because there is free flow of air.

Asthma medications work differently. Bronchodilators are used to stop the muscle spasms. Steroids are used to decrease inflammation and swelling of the airway lining. Both of these open up the airway and allow more air to flow. Patients should feel better because air is flowing and the wheezing should decrease. N.B. if wheezing is decreasing it could be because the airflow is improving or actually getting worse, so overall patient clinical status is very important to assess.

Today bronchodilator-steroids combination medications are often used. If used separately, bronchodilators are used first to help open up the airways quickly, and allow the steroid to better penetrate the airways.

Metered-dose inhalers can be difficult to use properly, especially having enough distance between the inhaler and the back of the mouth. Therefore spacers are recommended to be used by many adults and almost all children. Plastic spacers have an electrostatic charge which may cause the medication to stick to the inside of the spacer and not pass to the patient. “Priming” the spacer with ~6 puffs of bronchodilator usually suffices to block this charge and allows the medication to pass to the patient. Priming should be done again after about 1-2 weeks of daily use, if the spacer has not been used after 1-2 weeks, and after washing.

Explore Cases on PediatricEducation.org

Cases By Disease – Asthma
Cases By Disease – Asthma In Children
Cases By Symptom – Shortness of Breath

AI Generated Learning Materials from PediatricEducation.org Content (not reviewed)

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Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa

Today, 22 years to the week after starting PediatricEducation.org we are launching our next educational creation with Mastering Pediatrics.

Mastering Pediatrics’ goal is to advance learners’ pediatric clinical reasoning and knowledge. Experienced clinicians know that there is lots to learn that is not written down that helps us evaluate and treat patients. These Key Points and Cases can help learners analyze their current scientific knowledge, expand that knowledge and then apply it to clinical situations moving them from the novice to an intermediate or advanced learner stage. These Key Points are what experienced clinicians may discuss with learners in the short time frame of a clinical encounter. And experienced clinicians continue to learn or solidify their own knowledge.

In addition to imparting clinical experience, study materials including quizzes, study guides and a podcast at different learner levels are also included. Mastering Pediatrics Key Points and Cases are created by the authors, and the information is referenced and reviewed. Podcasts, study guides and quizzes are created by Gemini Artificial Intelligence. They are NOT REVIEWED for accuracy nor edited. The basic AI prompt will be available on the Archive page.

We hope you and your learners find it beneficial.

Donna M. D’Alessandro and Michael P. D’Alessandro
Curators, PediatricEducation.org

We promised to be back soon and we will be back on October 5th!

PediatricEducation.org will have a new way of looking at clinical encounters and learning for everyone.

We know that people learn differently and we think everyone will find something for themselves with the new cases and ways of following PediatricEducation.org including through social media.

Until October 5th, why not try a random case and see if you can answer the question!

Donna M. D’Alessandro and Michael P. D’Alessandro
Curators, PediatricEducation.org

The Chinese proverb says “A journey of a thousand miles begins with a single step”. That single step was September 30, 2004 and it started a journey of 1,000 general pediatric cases. What an amazing journey it has been!

What started as a way of extending learning after a clinical encounter for residents and medical students, has really highlighted how there is something to learn from every clinical encounter. PediatricEducation.org shows how many other people can benefit from those encounters as well.

So what is next? PediatricEducation.org is not going away. For the next few months, we are working on new ways to help extend the learning.

We will be back soon so don’t go away. Look at a Random Case from the navigation bar, go through a Curriculum Map or work through a Symptom or Speciality in the meantime.

We cannot have done it without our patrons, so we thank you for all of your feedback and support.

Donna M. D’Alessandro and Michael P. D’Alessandro
Curators, PediatricEducation.org