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Q:How to differentiate in bleeding or purpura, whether due to bleeding abnormality or coagulation abnormality? Bleeding into the skin and mucous membrane, purpura is less common or rare purpura is more common 4. Clotting time is normal, but bleeding time is platelet count are normal prolonged and platelet count is low 5. May be needed if persistent or potentially life- threatening bleeding or where emergency splenectomy is done.

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Symptoms result from these changes and may include wheezing, cough especially if worse at night, difficulty breathing, or chest tightness. A chest radiograph is not a required study but can help exclude other diagnoses such as congestive heart failure or in toddlers, foreign-body aspiration. Nonspecific findings of hyperinflation, flattened diaphragms, or increased bron- chial wall markings may be the only abnormalities seen with asthma.

Other tests such as sweat chloride testing may be needed to exclude other obstructive diseases of the small airways, such as cystic fibrosis. Viral bronchiolitis is the most com- monly occurring disease of the small airways and usually does not respond to con- ventional asthma therapy. Asthma management involves classifying the baseline disease severity and identi- fying and minimizing exposure to triggers.

The features that are assessed are the frequency of nighttime symptoms, how often the rescue medica- tion is needed, and how much symptoms limit daily activities. Severity is defined as either intermittent or persistent; persistent asthma is further divided into mild, moderate, or severe. Pharmacotherapy for asthma includes quick-relief medications for the acute symptoms and exacerbations, as well as long-term controller medications.

These agents also can be used immediately prior to exercise or exposure to allergens to minimize the acute asthmatic response. Increased levels of drug are delivered to the lungs and toxicity is decreased when these medications are delivered through inhalation routes nebulizer or inhaler. Patients must not over-rely on short-acting inhalers because this practice is associ- ated with death in severe asthma attacks.

The most potent available anti-inflammatory drugs are corticosteroids, which are useful for acute exacerbations oral or intravenous prednisone, prednisolone and for chronic therapy inhaled corticosteroids. The inhaled route is best for chronic therapy so that adverse effects on bone mineral density, growth, and immune function are minimized while maximal amounts of the drug can be delivered to the lungs.

Other long-term controller medications include mast cell stabilizers cromolyn, ned- ocromil and leukotriene modifiers montelukast, which act by reducing the immune response to allergen exposure. Any chronic condition such as poorly controlled asthma may result in failure to thrive.

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