A6-year-old boy has a 1-year history of moderate persistent asthma that is normally well controlled with budesonide via dry powder inhaler (dpi) twice a day and the use of albuterol once or twice a week as needed for wheezing. three days ago, he developed a sore throat, clear nasal discharge, and a dry cough. in the past 24 hours, he has had intermittent wheezing, necessitating the use of albuterol two puffs with use of an age-appropriate spacer every 3 hours) with partial relief. your next most appropriate action is to obtain:
a. a chest radiograph.
b. an oxygen saturation measurement.
c. a peak expiratory flow (pef) measurement.
d. a sputum smear for wbcs.

A peak expiratory flow (PEF) measurement

Explanation:

The peak expiratory flow (PEF), or peak expiratory flow rate (PEFR), is a person's maximum speed of expiration, as measured with a peak flow meter, a small, hand-held device used to monitor a person's ability to breath out air. It measures the airflow through the bronchi and thus the degree of obstruction in the airways. Peak expiratory flow is typically measured in units of liters per minute (L/min).

Measurements may be based on 1 second or less but are usually reported as a volume per minute. Electronic devices will sample the flow and multiply the same volume (Liters) by 60, divided by the sample (seconds) for a result measured in L/minute: (sample volume*60)/sample time.

Peak flow readings are often classified into 3 zones of measurement according to the American Lung Association, green, yellow, and red.

Green zone: 80 to 100 percent of the usual or normal peak flow readings are clear. A peak flow reading in the green zone indicates that the asthma is under good control.

Yellow zone: 50 to 59 percent of the usual or normal peak flow readings. Indicates caution. It may mean respiratory airways are narrowing and additional medication may be required.

Red zone: less than 50 percent of the usual or normal peak flow readings. Indicates medical emergency. Severe airway narrowing may be occurring and immediate action needs to be taken. This would usually involve contacting a doctor or hospital.

    however, coronary heart disease , or chd, is actually a result of coronary artery disease, or cad, said edward a. fisher, m.d., ph.d., m.p.h., an american heart association volunteer who is the leon h. charney professor of cardiovascular medicine and also of the marc and ruti bell vascular biology and disease program at the nyu school of medicine.

  with coronary artery disease, plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited. view an illustration of coronary arteries. this is also called ischemia. it may be chronic, narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle. or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or blood clot.

    the traditional risk factors for coronary artery disease are high ldl cholesterol, low hdl cholesterol, high blood pressure, family history, diabetes, smoking, being post-menopausal for women and being older than 45 for men, according to fisher. obesity may also be a risk factor.

    “coronary artery disease begins in childhood, so that by the teenage years, there is evidence that plaques that will stay with us for life are formed in most people,” said fisher, who is former editor of the american heart association journal, atvb. “preventive measures instituted early are thought to have greater lifetime benefits. healthy lifestyles will delay the progression of cad, and there is hope that cad can be regressed before it causes chd.”

  living a healthy lifestyle that incorporates good nutrition, weight management and getting plenty of physical activity can play a big role in avoiding cad.

    “coronary artery disease is preventable,” agreed johnny lee, m.d., president of new york heart associates, and an american heart association volunteer. “typical warning signs are chest pain, shortness of breath, palpitations and even fatigue.” if you feel any of these symptoms, don’t delay — call 9-1-1.