7.Exacerbare WR

8/19/2019 7.Exacerbare WR

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EVALUAREA SI ABORDAREAEVALUAREA SI ABORDAREA

TERAPEUTICA A CRIZELOR DETERAPEUTICA A CRIZELOR DEWHEEZING RECURENT LAWHEEZING RECURENT LA

SUGAR SI PRESCOLARSUGAR SI PRESCOLARCRAIU MIHAI MD PhDCRAIU MIHAI MD PhD

Medic primar pediatrMedic primar pediatrSpra!pecia"i#are p$em%"%&ie pediatricaSpra!pecia"i#are p$em%"%&ie pediatrica

IOMC 'A"(red R!e!c)IOMC 'A"(red R!e!c)


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PLANUL LUCRARIIPLANUL LUCRARII

* PREMIZEPREMIZE* EVALUAREA CLINICA A E+ACERBARII DEEVALUAREA CLINICA A E+ACERBARII DETIP BRONHOOBSTRUCTIV LA SUGAR SITIP BRONHOOBSTRUCTIV LA SUGAR SI

PRESCOLARPRESCOLAR* ABORDAREA INITIALA A E+ACERBARIIABORDAREA INITIALA A E+ACERBARII* EVOLUTIA E+ACERBARIIEVOLUTIA E+ACERBARII

* PLANURI LA E+TERNARE, PROGRAMEPLANURI LA E+TERNARE, PROGRAMEEDUCATIONALE, MONITORIZAREEDUCATIONALE, MONITORIZARE* CONCLUZIICONCLUZII


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* PREMIZEPREMIZE* EVALUAREA CLINICA A E+ACERBARII DEEVALUAREA CLINICA A E+ACERBARII DETIP BRONHOOBSTRUCTIV LA SUGAR SITIP BRONHOOBSTRUCTIV LA SUGAR SI

PRESCOLARPRESCOLAR* ABORDAREA INITIALA A E+ACERBARIIABORDAREA INITIALA A E+ACERBARII* EVOLUTIA E+ACERBARIIEVOLUTIA E+ACERBARII

* PLANURI LA E+TERNARE, PROGRAMEPLANURI LA E+TERNARE, PROGRAMEEDUCATIONALE, MONITORIZAREEDUCATIONALE, MONITORIZARE* CONCLUZIICONCLUZII


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ASTMUL - PROBLEMA DEASTMUL - PROBLEMA DESANATATE PUBLICASANATATE PUBLICA

* G"%.a" !e e!timea#a % ci(ra de /011 mi"i%a$eG"%.a" !e e!timea#a % ci(ra de /011 mi"i%a$epacie$ti c a!tm2pacie$ti c a!tm2

* E!te cea mai (rec3e$ta .%a"a cr%$ica i$E!te cea mai (rec3e$ta .%a"a cr%$ica i$c%pi"arie4c%pi"arie4

4 Marti$e# 5 6 Heter%&e$eit7 i$ Whee#i$& I""$e!! i$4 Marti$e# 5 6 Heter%&e$eit7 i$ Whee#i$& I""$e!! i$

Chi"dre$Chi"dre$ i$ !ecti$ea ASTHMA PHENOT8PES9 5ROMi$ !ecti$ea ASTHMA PHENOT8PES9 5ROMMOLECULAR TO CLINICAL 6 :; Mai


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BOLILE CRONICE ALE COPILULUIBOLILE CRONICE ALE COPILULUI

* Cea mai (rec3e$ta .%a"aCea mai (rec3e$ta .%a"acr%$ica a c%pi"ariei -cr%$ica a c%pi"ariei -ASTMUL BROSIC 4ASTMUL BROSIC 4

4 SUA ?,; mi" c%pii @ 0, mi" eacer.


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* Ime$!a maK%ritate a pacie$ti"%r a de.t"Ime$!a maK%ritate a pacie$ti"%r a de.t"a(ecti$ii i$ c%pi"arie4a(ecti$ii i$ c%pi"arie4

* di$ ad"ti c a!tm a a3t !impt%me i$ di$ ad"ti c a!tm a a3t !impt%me i$primii a$i de 3iata44primii a$i de 3iata444 Marti$e# 5 6 Heter%&e$eit7 i$ Whee#i$& I""$e!! i$4 Marti$e# 5 6 Heter%&e$eit7 i$ Whee#i$& I""$e!! i$Chi"dre$Chi"dre$ i$ !ecti$ea ASTHMA PHENOT8PES9 5ROMi$ !ecti$ea ASTHMA PHENOT8PES9 5ROMMOLECULAR TO CLINICAL 6 :; Mai 44 Bi!&aard H, S#e("er S 6 Pre3a"e$ce %( A!thmaFLiePre3a"e$ce %( A!thmaFLieS7mpt%m! i$ 8%$& Chi"dre$S7mpt%m! i$ 8%$& Chi"dre$ Pediatric P"m%$%"%&7 Pediatric P"m%$%"%&7


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* Pre#e$tari"e "a CPU pe$tr eacer.ari de a!tm !$tPre#e$tari"e "a CPU pe$tr eacer.ari de a!tm !$t(rec3e$te i$ c%pi"arie ?; di$ pacie$tii c(rec3e$te i$ c%pi"arie ?; di$ pacie$tii ceacer.are i$ SUA * Vi#ite"e "a CPU !$t c%$!iderate ca e!ec aVi#ite"e "a CPU !$t c%$!iderate ca e!ec a

!trate&iei de pre3e$tie4!trate&iei de pre3e$tie44 C%$de!!a Pitre# PM, Stei$ RS, Marti$e# 5D 6 Cap > The G"%.a" Brde$4 C%$de!!a Pitre# PM, Stei$ RS, Marti$e# 5D 6 Cap > The G"%.a" Brde$

%( A!thma%( A!thma i$ Pediatric Re!pirat%r7 Medici$e ed


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* Deteremi$area pre3a"e$Qei, impact"i iDeteremi$area pre3a"e$Qei, impact"i itratame$t"i !impt%me"%r !peci(ice a!tm"i "atratame$t"i !impt%me"%r !peci(ice a!tm"i "ac%piii prec%"aric%piii prec%"ari

* I$ter3i te"e(%$ic "a ;


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Che!ti%$arChe!ti%$ar:>:> C%pi"" dF3%a!tr a a3t $ "time"e ? "$iC%pi"" dF3%a!tr a a3t $ "time"e ? "$i

epi!%ade repetate deepi!%ade repetate de t!et!e dera$Ka$tdera$Ka$t C%pi"" dF3%a!tr a a3t $ "time"e ? "$iC%pi"" dF3%a!tr a a3t $ "time"e ? "$i

peri%ade cperi%ade c

re!piraQie dera$Ka$t !are!piraQie dera$Ka$t !a

#&%m%t%a!#&%m%t%a! hria", iertr, mrmr,hria", iertr, mrmr,.%".%r%!ea" !a a"te #&%m%te $e%.i$ite.%".%r%!ea" !a a"te #&%m%te $e%.i$ite0>0> C%pi"" dF3%a!tr a !(erit $ "time"e ? "$iC%pi"" dF3%a!tr a !(erit $ "time"e ? "$i

dede re!piraQie $trerpt !a di(ici"re!piraQie $trerpt !a di(ici"

>> $ "time"e ? "$i a primit c%pi"" dF3%a!tr$ "time"e ? "$i a primit c%pi"" dF3%a!trmedicame$temedicame$te ta."ete, !ir%pri !a p(rita."ete, !ir%pri !a p(ripre!cri!e pe$tr !impt%me re!pirat%riipre!cri!e pe$tr !impt%me re!pirat%rii!prt%are!prt%are


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Re#"tate

* 01;; 0


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O.iceiri de tratame$t O.iceiri de tratame$t


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EVOLUTIA TEMPORALA AEVOLUTIA TEMPORALA APREVALENTEI WRPREVALENTEI WR


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* SI IN ROMANIA4SI IN ROMANIA4

: N%3 6 0: Dec


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ASTMUL BRONSIC LA COPIL IN ROMANIAASTMUL BRONSIC LA COPIL IN ROMANIA

* Pre3a"e$ta i$ cre!tere "a $i3e" $ati%$a" 4Pre3a"e$ta i$ cre!tere "a $i3e" $ati%$a" 46 ?> "a c%pii de ?F; a$i?> "a c%pii de ?F; a$i6 ;> Ghe%$ea, D> A> P"e!ca, D> Dra&%mir, D> Ora!ea$, I>C> Ghe%$ea, D> A> P"e!ca, D> Dra&%mir, D> Ora!ea$, I>Cer$ate!c, M> Na$"e!c, M> Neamt, N> Bi!ca, P> Chereche!FCer$ate!c, M> Na$"e!c, M> Neamt, N> Bi!ca, P> Chereche!F

Pa$ta, S> G%tia F Pre3a"e$ce %( a!thma i$ chi"dre$ i$ R%ma$iaPa$ta, S> G%tia F Pre3a"e$ce %( a!thma i$ chi"dre$ i$ R%ma$iar.a$ area! 6 A.!tract


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Pre3a"e$ce %( a!thma a$d a""er&ie! i$ chi"dre$


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E+ACERBARILE BO LA COPILE+ACERBARILE BO LA COPIL

Peri%dicitate a$a"a F ma SeptPeri%dicitate a$a"a F ma Sept


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* Cea mai mare '!r!a) de eacer.ari, 3i#iteCea mai mare '!r!a) de eacer.ari, 3i#ite$epr%&ramate "a CPU !i !pita"i#ari %$epr%&ramate "a CPU !i !pita"i#ari %repre#i$ta p%p"atia r.a$a c 3e$it !ca#t>repre#i$ta p%p"atia r.a$a c 3e$it !ca#t>

* Pri$tre a"te !trate&ii de pre3e$tie ar pteaPri$tre a"te !trate&ii de pre3e$tie ar ptea(i ame"i%rarea d&, tratame$t"i !i edcatia(i ame"i%rarea d&, tratame$t"i !i edcatia"a CPU dpa % eacer.are4"a CPU dpa % eacer.are4

4 C%$de!!a Pitre# PM, Stei$ RS, Marti$e# 5D 6 Cap > The4 C%$de!!a Pitre# PM, Stei$ RS, Marti$e# 5D 6 Cap > TheG"%.a" Brde$ %( A!thmaG"%.a" Brde$ %( A!thma i$ Pediatric Re!pirat%r7 Medici$ei$ Pediatric Re!pirat%r7 Medici$eed


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* PREMIZEPREMIZE* EVALUAREA CLINICA A E+ACERBARII DEEVALUAREA CLINICA A E+ACERBARII DETIP BRONHOOBSTRUCTIV LA SUGAR SITIP BRONHOOBSTRUCTIV LA SUGAR SIPRESCOLARPRESCOLAR

* ABORDAREA INITIALA A E+ACERBARIIABORDAREA INITIALA A E+ACERBARII* EVOLUTIA E+ACERBARIIEVOLUTIA E+ACERBARII

* PLANURI LA E+TERNARE, PROGRAMEPLANURI LA E+TERNARE, PROGRAMEEDUCATIONALE, MONITORIZAREEDUCATIONALE, MONITORIZARE* CAZ CLINICCAZ CLINIC

* CONCLUZIICONCLUZII


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EVALUAREA CLINICA A E+ACERBARIIEVALUAREA CLINICA A E+ACERBARIIDE TIP BRONHOOBSTRUCTIV LADE TIP BRONHOOBSTRUCTIV LA

SUGAR SI PRESCOLARSUGAR SI PRESCOLAR

* E!te (%"%!it $ !c%r c"i$ic pe$trde(i$irea a c"a!e de !e3eritate aeacer.arii96 5%rma !%ara6 5%rma medie

6 5%rma !e3era6 Imi$e$ta de !t%p re!pirat%r


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EVALUAREA CLINICA A E+ACERBARIIEVALUAREA CLINICA A E+ACERBARIIDE TIP BRONHOOBSTRUCTIV LADE TIP BRONHOOBSTRUCTIV LA

SUGAR SI PRESCOLAR 4SUGAR SI PRESCOLAR 4


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TAHIPNEETAHIPNEE


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EVALUARE CLINICAEVALUARE CLINICA


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GAZELE SANGUINE SIGAZELE SANGUINE SI

PULSO+IMETRIAPULSO+IMETRIA


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Frecventa Sugar Copil

Rapid /


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CRITERII DE SEVERITATECRITERII DE SEVERITATE

F dpd3 circ"at%r FF dpd3 circ"at%r F* Sem$e de hip%per(#ie !e3eraSem$e de hip%per(#ie !e3era

6 O.$.i"at @ "etar&icO.$.i"at @ "etar&ic6 O"i&%a$ricO"i&%a$ric6 P"!ri peri(erice a.!e$teP"!ri peri(erice a.!e$te6 P"!ri ce$tra"e (i"i(%rmeP"!ri ce$tra"e (i"i(%rme

* Bradiaritmie ?1@mi$Bradiaritmie ?1@mi$* hTAhTA


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CRITERII DE SEVERITATECRITERII DE SEVERITATE

* POTENTIAL AMENINTATOARE DEPOTENTIAL AMENINTATOARE DEVIATA SUNTVIATA SUNT DOARDOAR E+ACERBARILE CUE+ACERBARILE CU

IMPACT HEMODINAMICIMPACT HEMODINAMIC

* NU TREBUIESC SUPRAEVALUATENU TREBUIESC SUPRAEVALUATE

SEMNELE DE COMPENSARESEMNELE DE COMPENSAREHEMODINAMICA SI INTERPRETATE CAHEMODINAMICA SI INTERPRETATE CA5IIND CONTRAIND> TERAPEUTICAYYY5IIND CONTRAIND> TERAPEUTICAYYY


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PLANUL LUCRARIIPLANUL LUCRARII*

PREMIZEPREMIZE

* EVALUAREA CLINICA A E+ACERBARII DEEVALUAREA CLINICA A E+ACERBARII DETIP BRONHOOBSTRUCTIV LA SUGAR SITIP BRONHOOBSTRUCTIV LA SUGAR SIPRESCOLARPRESCOLAR





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TRATAMENTUL CRIZEITRATAMENTUL CRIZEI

PRIORITATILE TERAPEUTICEPRIORITATILE TERAPEUTICE* A.%rdarea terapetica a %ricari pacie$tA.%rdarea terapetica a %ricari pacie$t

c a(ecti$e !e3era tre.ie !a re!pectec a(ecti$e !e3era tre.ie !a re!pectepri%ritati"e PALSpri%ritati"e PALS

* Ordi$ea de a.%rdare e!te ABCOrdi$ea de a.%rdare e!te ABC6

A 6 Aira7 Ca"e Aeria$aA 6 Aira7 Ca"e Aeria$a

6 B 6 Breathi$& Re!piratiaB 6 Breathi$& Re!piratia6 C 6 Circ"ati%$ Circ"atiaC 6 Circ"ati%$ Circ"atia


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AIRWA8 CALEAAIRWA8 CALEAAERIANAAERIANA

* Me$ti$erea caiiMe$ti$erea caiiaerie$e "i.ereaerie$e "i.ere6 P%#iti%$are ca"e aeria$aP%#iti%$are ca"e aeria$a

6 A!pirare !ecretiiA!pirare !ecretii


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DISPOZITIVE PENTRU CALEADISPOZITIVE PENTRU CALEAAERIANAAERIANA

La pacie$tii cLa pacie$tii c

!c%r G"a!&% !c%r G"a!&% 6 Pipa Gede"Pipa Gede"6 P%#itia !i&ra$taP%#itia !i&ra$ta

6 S%$da NG@OGS%$da NG@OG


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BREATHING RESPIRATIABREATHING RESPIRATIA* Admi$i!trarea ce"ei mai mariAdmi$i!trarea ce"ei mai mari

ca$titati t%"erate de %i&e$ca$titati t%"erate de %i&e$* Mi$ima"i#area detre!eiMi$ima"i#area detre!ei6 A&itatia DUBLEAZA Ra i$ ("A&itatia DUBLEAZA Ra i$ ("

"ami$ar Ra :@r"ami$ar Ra :@rLL iar "a ("iar "a ("

tr."e$t :@rtr."e$t :@rMM


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ADMINISTRAREA CELUI MAIADMINISTRAREA CELUI MAIMARE 5LU+ DE OMARE 5LU+ DE O


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ADMINISTRAREA CELUI MAIADMINISTRAREA CELUI MAIMARE 5LU+ DE OMARE 5LU+ DE O


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ADMINISTRAREA CELUI MAIADMINISTRAREA CELUI MAI

MARE 5LU+ DE OMARE 5LU+ DE O


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medicatia .r%$h%di"atat%aremedicatia .r%$h%di"atat%are

SECVENTA DE ATAC - Ce" pti$ 0 d%#e i$ ?1 mi$teSECVENTA DE ATAC - Ce" pti$ 0 d%#e i$ ?1 mi$te


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5ARMACOECHIVALENTA5ARMACOECHIVALENTA

* Ne."i#area meda a!i&ra % dep$ereNe."i#area meda a!i&ra % dep$ere

i$trap"m%$ara a [i$trap"m%$ara a [<<

adre$er&ice"%radre$er&ice"%rSIMILARASIMILARA c admi$i!trarea de pMDI cc admi$i!trarea de pMDI c!pacer>!pacer>


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Echi3a"e$ta i$ cr!" SECVENTEI DE ATACEchi3a"e$ta i$ cr!" SECVENTEI DE ATAC


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CORTICOSTEROIZII SIST CORTICOSTEROIZII SIST

* Daca $ pacie$t c eacer.aremedie@!e3era $ ra!p$de .i$e "aadre$er&ice i$ha"at%rii SECV ATAC !e3%r admi$i!tra CS SI NU ICS6 m&@X& HHC i3

6 :F< m& Pred$i!%$ p%


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CORTICOSTEROIZII INHCORTICOSTEROIZII INH

* 5%"%!irea ICS pe$tr tratame$t" eacer.arii5%"%!irea ICS pe$tr tratame$t" eacer.ariie!te c%$tr%3er!ata4e!te c%$tr%3er!ata4

6


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STRATEGIA 'SMART)

* 5%"%!irea atat ca tratame$t de (%$d !i ca're"ie3er) a c%m.i$atiei (ie BUD\5ORMOT>


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PLANUL LUCRARIIPLANUL LUCRARII* PREMIZEPREMIZE* EVALUAREA CLINICA A E+ACERBARII DEEVALUAREA CLINICA A E+ACERBARII DE

TIP BRONHOOBSTRUCTIV LA SUGAR SITIP BRONHOOBSTRUCTIV LA SUGAR SIPRESCOLARPRESCOLAR





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EVOLUTIA E+ACERBARIIEVOLUTIA E+ACERBARII


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* E3%"tia (a3%ra.i"a c dec"i$" (e$%me$e"%rde detre!a tre.ie !a apara i$ ce" m"t :F


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* Ra!p$!" i$adec3at "aCORTICOSTEROIZI SISTEMICI ADRENERGICE imp$e admi$i!trarea de6 Te%(i"i$a i3

* ? m&@& INCARCARE ap%i 1,F: m&@&@h PEV6 S"(at de M& i3, i$ha"at%ri


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Criterii de eter$are di$ CPUCriterii de eter$are di$ CPU

(ara ri!cri maK%re4(ara ri!cri maK%re46 Var!ta / < L,Var!ta / < L,6 5ara i!t%ric de i$t.atie,5ara i!t%ric de i$t.atie,6 I!t%ric de ec#ema \,I!t%ric de ec#ema \,

6 5ara tahip$ee @ mi$ "a 1F< L, 0 @mi$ "a


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PREVENTIE E+ACERBAREPREVENTIE E+ACERBARE

* EVALUAREA TERAPIEI DE 5OND,EVALUAREA TERAPIEI DE 5OND,PERIODICPERIODIC6 5OLOSIREA SCOR ATA_ ASTHMA5OLOSIREA SCOR ATA_ ASTHMA

THERAP8 ASSESMENT _UESTIONAIRETHERAP8 ASSESMENT _UESTIONAIRELUNAR, PANA LA OBTINERE CONTROLLUNAR, PANA LA OBTINERE CONTROL

* CRONO5ARMACOLOGIECRONO5ARMACOLOGIE

6 A CU E+ACERBARI NOCTURNE SEVEREA CU E+ACERBARI NOCTURNE SEVERE* TEO5ILINA IN PRIZA UNICA SEARATEO5ILINA IN PRIZA UNICA SEARA* CS LA 0 PM DECAT LA ?, :CS LA 0 PM DECAT LA ?, :


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POSTCRITIC 6 ARE ASTMPOSTCRITIC 6 ARE ASTM


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POSTCRITIC 6 ARE ASTMPOSTCRITIC 6 ARE ASTM


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DERMATITA ATOPICADERMATITA ATOPICA

RINOCONUNCTIVITARINOCONUNCTIVITA


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RINOCONUNCTIVITARINOCONUNCTIVITAALERGICAALERGICA


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Er Re!pir


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M%de"e temp%ra"e de hee#i$&M%de"e temp%ra"e de hee#i$&(e$%tipri(e$%tipri

* Whee#i$& epi!%dic 3ira"9Whee#i$& epi!%dic 3ira"96 Whee#i$& $ epi!%ade !crte de timp,Whee#i$& $ epi!%ade !crte de timp,6 A!%ciate de!e%ri c e3ide$Qe c"i$ice de i$(ecQiiA!%ciate de!e%ri c e3ide$Qe c"i$ice de i$(ecQii

re!pirat%rii 3ira"ere!pirat%rii 3ira"e6 Lip!a !impt%me"%r $tre epi!%adeLip!a !impt%me"%r $tre epi!%ade

* Whee#i$& c tri&&eri m"tip"iWhee#i$& c tri&&eri m"tip"i

6 Whee#i$& care pre#i$t peri%ade de eacer.riWhee#i$& care pre#i$t peri%ade de eacer.ridar pre#i$t !impt%me i $tre epi!%adedar pre#i$t !impt%me i $tre epi!%ade

Er Re!pir


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* 5e$%tipri"e $ !e re(era "a m%da"itati"e5e$%tipri"e $ !e re(era "a m%da"itati"e

e3%"ti3e de(i$ite retr%!pecti3, pri$ i!t%riae3%"ti3e de(i$ite retr%!pecti3, pri$ i!t%ria$atra"a a .%"ii$atra"a a .%"ii

5e$%tipri5e$%tipri


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Whee#i$& epi!%dic 3ira"Whee#i$& epi!%dic 3ira"

* Ace!t (e$%tip apare ce" mai (rec3e$t "a c%piiiAce!t (e$%tip apare ce" mai (rec3e$t "a c%piiiprec%"ariprec%"ari

* A!%ciat c !em$e c"i$ice de i$(ecQii 3ira"e a"eA!%ciat c !em$e c"i$ice de i$(ecQii 3ira"e a"e

ci"%r re!pirat%riici"%r re!pirat%rii* Cei mai (rec3e$Qi a&e$Qi imp"icaQi9 rhi$%3ir!,Cei mai (rec3e$Qi a&e$Qi imp"icaQi9 rhi$%3ir!,3ir!" !i$ciQia" re!pirat%r VSR, c%r%$a3ir!,3ir!" !i$ciQia" re!pirat%r VSR, c%r%$a3ir!,hma$ metap$em%3ir!, 3ir!" para&ripa" ihma$ metap$em%3ir!, 3ir!" para&ripa" i

ade$%3ir!ade$%3ir!* Epi!%ade"e repetate ti$d ! apar c caracterEpi!%ade"e repetate ti$d ! apar c caracter!e#%$ier t%am$a 6 iar$a!e#%$ier t%am$a 6 iar$a

* De %.icei di!pare p$ "a 3r!ta de ? a$iDe %.icei di!pare p$ "a 3r!ta de ? a$iEr Re!pir


58/81

Whee#i$& c tri&&er m"tip"Whee#i$& c tri&&er m"tip"

* I$(ecQii"e 3ira"e a"e ci"%r re!pirat%riiI$(ecQii"e 3ira"e a"e ci"%r re!pirat%rii!peri%are repre#i$t ce" mai (rec3e$t tri&&er!peri%are repre#i$t ce" mai (rec3e$t tri&&er

* Pre#i$t i a"Qi tri&&eri (m" de Qi&ar,Pre#i$t i a"Qi tri&&eri (m" de Qi&ar,

a"er&e$i, ceaQ, p"$!, r! !a eerciQiia"er&e$i, ceaQ, p"$!, r! !a eerciQii* Simpt%me"e !$t pre#e$te i $tre epi!%ade"eSimpt%me"e !$t pre#e$te i $tre epi!%ade"ede hee#i$&de hee#i$&

Er Re!pir


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EVALUAREEVALUARERec%ma$dri ERS Ta! 5%rceRec%ma$dri ERS Ta! 5%rce

:>:> ''Patter$F") i tri&&erii hee#i$&F"i,Patter$F") i tri&&erii hee#i$&F"i,i!t%ric" (ami"ia" i per!%$a" de at%pie ii!t%ric" (ami"ia" i per!%$a" de at%pie i(mat" $ "%ciQ tre.ie e3a"ate pri$(mat" $ "%ciQ tre.ie e3a"ate pri$

a$am$e#a$am$e# Whee#i$&F" rap%rtat de ctre pri$QiWhee#i$&F" rap%rtat de ctre pri$Qitre.ie c%$(irmat de ctre per!%$a""tre.ie c%$(irmat de ctre per!%$a""

medica"4medica"4

0>0> A"te i$3e!ti&aQii $ tre.ie e(ectateA"te i$3e!ti&aQii $ tre.ie e(ectatedect dac hee#i$&F" e!te $e%.i$itdect dac hee#i$&F" e!te $e%.i$itde !e3er !a re#i!te$t "a tratame$tde !e3er !a re#i!te$t "a tratame$t

Er Re!pir


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WR '!ec%$dFha$d !m%i$&)WR '!ec%$dFha$d !m%i$&)

* I$trF$ !tdi pr%!pecti3 4I$trF$ !tdi pr%!pecti3 4a!pra 1 !&ari !pita"i#atia!pra 1 !&ari !pita"i#atiIOMC c .r%$!i%"ita !e3era i$IOMC c .r%$!i%"ita !e3era i$iar$a


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EVALUARE


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SPIROMETRIESPIROMETRIE


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REVERSIBILITATEREVERSIBILITATE


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TRATAMENT TRATAMENT

* Dpa c%$tr%""Dpa c%$tr%""eacer.arii !e p$eeacer.arii !e p$epr%."ema ce medicatiepr%."ema ce medicatie

'de (%$d) 3%m (%"%!i'de (%$d) 3%m (%"%!i* I$ WR !$t citate d%ar


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CSICSI

* E(icie$Qi $ hee#i$&F" c tri&&eri m"tip"iE(icie$Qi $ hee#i$&F" c tri&&eri m"tip"i* Simpt%me"e (rec3e$te, 3r!ta !. < a$i i@!aSimpt%me"e (rec3e$te, 3r!ta !. < a$i i@!a

i!t%ric" (ami"ia" de a!tm pre#ic $ r!p$!i!t%ric" (ami"ia" de a!tm pre#ic $ r!p$!

.$ "a ("tica#%$


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M%$te"a!tM%$te"a!t

* Whee#i$&F" c tri&&eri m"tip"iWhee#i$&F" c tri&&eri m"tip"i6 Rea"i#ea# pr%tecQie mp%tri3a .r%$h%c%$!tricQieiRea"i#ea# pr%tecQie mp%tri3a .r%$h%c%$!tricQiei

i$d!e de hiper3e$ti"aQia c aer rece !cati$d!e de hiper3e$ti"aQia c aer rece !cat6 m.$tQete !impt%mat%"%&ia i redce c 01m.$tQete !impt%mat%"%&ia i redce c 01

eacer.ri"eeacer.ri"e* Whee#i$&F" epi!%dicWhee#i$&F" epi!%dic

6 Uti"i#area #i"$ic deFa "$&" $i a$ a red! (rec3e$QaUti"i#area #i"$ic deFa "$&" $i a$ a red! (rec3e$Qaepi!%ade"%r de hee#i$& c 0


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Whee#i$& c tri&&er m"tip"Whee#i$& c tri&&er m"tip"Tratame$t de $treQi$ereTratame$t de $treQi$ere

:>:> CSI $ d%# #i"$ic p$ "a 11CSI $ d%# #i"$ic p$ "a 11 ^& echi3a"e$t BDP^& echi3a"e$t BDP:>:> Creterea "i$ear tre.ie m!rat c%$!ta$t "a c%piii prec%"ariCreterea "i$ear tre.ie m!rat c%$!ta$t "a c%piii prec%"aricare ti"i#ea# CSIcare ti"i#ea# CSI

C%pii"%r !. : a$ ar tre.i pr%.a.i" ! $ "i !e pre!crie CSIC%pii"%r !. : a$ ar tre.i pr%.a.i" ! $ "i !e pre!crie CSI0>0> C%pii"%r $tre : i < a$i tre.ie ! "i !e pre!crie CSI d%ar dacC%pii"%r $tre : i < a$i tre.ie ! "i !e pre!crie CSI d%ar dac

!impt%me"e !$t !prt%are i arat $ r!p$! c"ar "a!impt%me"e !$t !prt%are i arat $ r!p$! c"ar "atratame$ttratame$t>> R!p$!" $e(a3%ra.i" $ tre.ie rmat de creterea d%#ei ciR!p$!" $e(a3%ra.i" $ tre.ie rmat de creterea d%#ei ci

de % ree3a"are, iar r!p$!" (a3%ra.i" tre.ie ! dc "ade % ree3a"are, iar r!p$!" (a3%ra.i" tre.ie ! dc "a $trerperea tratame$t"i dp cte3a !ptm$i !a "$i $trerperea tratame$t"i dp cte3a !ptm$i !a "$i

O cr de m%$te"a!t p%ate (i "at $ c%$!iderare "aO cr de m%$te"a!t p%ate (i "at $ c%$!iderare "ac%piii prec%"ari c hee#i$& c tri&&er m"tip"c%piii prec%"ari c hee#i$& c tri&&er m"tip"0>0> Cr%m%$e"e, et%ti(e$" !a a$ti$e"e NU !$tCr%m%$e"e, et%ti(e$" !a a$ti$e"e NU !$t

rec%ma$daterec%ma$date

Er Re!pir


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Whee#i$& epi!%dic 3ira"Whee#i$& epi!%dic 3ira"Tratame$t de $treQi$ereTratame$t de $treQi$ere

:>:> M%$te"a!t m& #i"$ic tre.ie pr%.a.i" ! (ie admi$i!trat ca iM%$te"a!t m& #i"$ic tre.ie pr%.a.i" ! (ie admi$i!trat ca itratame$t a" hee#i$&F"i epi!%dic 3ira"tratame$t a" hee#i$&F"i epi!%dic 3ira"

* Tratame$t c%$ti$ pe drata !e#%$"i rece !a ca i tratame$t epi!%dicTratame$t c%$ti$ pe drata !e#%$"i rece !a ca i tratame$t epi!%dicadmi$i!trat imediat ce apar !impt%me"e $ei rce"iadmi$i!trat imediat ce apar !impt%me"e $ei rce"i

O cr de CSI p%ate (i "at $ c%$!iderare "a aceti c%pii, maiO cr de CSI p%ate (i "at $ c%$!iderare "a aceti c%pii, maia"e! dac epi!%ade"e apar (rec3e$t !a i!t%ric" (ami"ia" de a!tma"e! dac epi!%ade"e apar (rec3e$t !a i!t%ric" (ami"ia" de a!tme!te p%#iti3e!te p%#iti3

Er Re!pir


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PREZENTARE DE CAZPREZENTARE DE CAZ


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PREZENTARE DE CAZPREZENTARE DE CAZS&ar :1 "$i pre#e$tat "a CPU IOMC cS&ar :1 "$i pre#e$tat "a CPU IOMC c

detre!a maK%ra, cia$%#a &e$era"i#atadetre!a maK%ra, cia$%#a &e$era"i#ataG"a!&%G"a!&% =F:1=F:1


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EVOLUTIE :EVOLUTIE :

* Ve$t%"i$ 1, $e."i#areVe$t%"i$ 1, $e."i#aremedameda* Oi&e$ pe ma!ca (" //Oi&e$ pe ma!ca (" //

* Deameta#%$a i3Deameta#%$a i3* Te!t rapid VSR \\Te!t rapid VSR \\


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EVOLUTIE


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EVOLUTIE 0EVOLUTIE 0

* M%$te"a!t m&@#i*


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:>:> De#3%"tarea parte$eriat"iDe#3%"tarea parte$eriat"ipacie$t@pari$te@medicpacie$t@pari$te@medic

Ide$ti(icarea !i redcerea ep$erii "aIde$ti(icarea !i redcerea ep$erii "a(act%rii de ri!c pe$tr a!tm(act%rii de ri!c pe$tr a!tm0>0> E3a"area, Tratame$t" !i M%$it%ri#area A!tmE3a"area, Tratame$t" !i M%$it%ri#area A!tm

>> Ma$a&eme$t" eacer.ari"%rMa$a&eme$t" eacer.ari"%r

>

C%$!ideratii !pecia"eC%$!ideratii !pecia"e

GINA 6 ASTHMA MANAGEMENT PREVENTIONGINA 6 ASTHMA MANAGEMENT PREVENTION

''Edcati%$ a! !i&$i(ica$t"7 a!!%ciated ith "e!!Edcati%$ a! !i&$i(ica$t"7 a!!%ciated ith "e!!

eacer.ati%$! p - 1>111eacer.ati%$! p - 1>111t% 1>1?1?tri&&eri$& (act%r! (%r eacer.ati%$ i$ pre!ch%%" 3ira" hee#e>

A.!tract :


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* ABORDAREA INITIALA A E+ACERBARIIABORDAREA INITIALA A E+ACERBARII* EVOLUTIA E+ACERBARIIEVOLUTIA E+ACERBARII*

PLANURI LA E+TERNARE, PROGRAMEPLANURI LA E+TERNARE, PROGRAMEEDUCATIONALE, MONITORIZAREEDUCATIONALE, MONITORIZARE

* CAZ CLINICCAZ CLINIC



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CONCLUZII :CONCLUZII :

* Eacer.ari"e de tip .r%$h%%.!trcti3 !$t(rec3e$te SI i$ R%ma$ia : di$pre#e$tari"e "a CPU i$ cr!" ier$ii>


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CONCLUZII


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CONCLUZII 0CONCLUZII 0* Terapia epi!%d"i act de BRONSIOLITA

p%ate (i (acta c6 Oi&e$%terapie6 AEROSOLI c ADRENALINA i$ (%rme"e

!e3ere

* Terapia epi!%d"i act de WR p%ate (i

(acta c6 ADRENERGICE6 CS ICS 6 d%#e 'ria!e)6 TEO5ILINA

CONCLUZ


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CONCLUZII CONCLUZII * Tratame$t" rec%ma$dat "teri%r $%rTratame$t" rec%ma$dat "teri%r $%r

epi!%ade !e3ere de .r%$h%!pa!m e!teepi!%ade !e3ere de .r%$h%!pa!m e!teM%$te"a!t m&9M%$te"a!t m&96 BRONSIOLITA ACUTA GRAVA F Cr !crtBRONSIOLITA ACUTA GRAVA F Cr !crt

admi$i!trat "a prim" !em$ de rcea", catadmi$i!trat "a prim" !em$ de rcea", catdrea#a a(ecti$ea acta, "a c%pii < a$idrea#a a(ecti$ea acta, "a c%pii < a$i6 WR / epi!%ade@"time"e :< " !a / 0 i$WR / epi!%ade@"time"e :< " !a / 0 i$

"time"e ? " Admi$i!trare pe terme$ "$& ce""time"e ? " Admi$i!trare pe terme$ "$& ce"pQi$ pe peri%ada !e#%$"i rece, idea" : a$ depQi$ pe peri%ada !e#%$"i rece, idea" : a$ de"a "tima cri#a !e3era"a "tima cri#a !e3era

CONCLUZII


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CONCLUZII CONCLUZII

* Tratame$t" rec%ma$dat pe$tr WR, "aTratame$t" rec%ma$dat pe$tr WR, "a

e!ec" tratam c M%$te"a!t 3a (i c ICSe!ec" tratam c M%$te"a!t 3a (i c ICSepi!%dic hDepi!%dic hD6 11 6 :111 micr%&rame@#i 5"i%tide $e."e!11 6 :111 micr%&rame@#i 5"i%tide $e."e!6 D%ar pe drata .%"iii acte, ;F: #i"eD%ar pe drata .%"iii acte, ;F: #i"e

6 A!%ciat c Ve$t%"i$ i$ha"at%riA!%ciat c Ve$t%"i$ i$ha"at%ri

CONCLUZII ?CONCLUZII ?


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CONCLUZII ?CONCLUZII ?

TERMINOLOGIETERMINOLOGIE6 C%$!e$!" PRACTALL rec%ma$dC%$!e$!" PRACTALL rec%ma$dti"i#area terme$"iti"i#area terme$"i

* a!tm i$d! 3ira" mai ti" $ practic 6 e>a!tm i$d! 3ira" mai ti" $ practic 6 e>rec%ma$dri terapeticerec%ma$dri terapetice

6 ERS rec%ma$d (%"%!irea terme$i"%rERS rec%ma$d (%"%!irea terme$i"%r* hee#i$& epi!%dic 3ira" ihee#i$& epi!%dic 3ira" i* hee#i$& c tri&&eri m"tip"iihee#i$& c tri&&eri m"tip"ii

Documents

7.Exacerbare WR