1. MTB Step 3 - Asthma Flashcards
Cards Complete Day 1: 4/23/19 * Day 2: 4/25/19 * Day 3: 5/3/19 * Day 4: 5/23/19 Day 5: 6/22/19
INTRODUCTION
What are (2) Clinical Manifestations of mild-to-moderate Asthma?
- Shortness of Breath (SOB)
- Expiratory Wheezing
INTRODUCTION
What are (2) additional Clinical Manifestations of severe Asthma?
- Use of Accessory Muscles
- Unable to Speak in Complete Sentences
INTRODUCTION
What are the (5) Most Important Features of Severe Asthma?
- Hypoxia
- Hyperventilation (increased respiratory rate)
- Respiratory Acidosis
- Decrease in Peak Flow
- Possible Absence of Wheezing (beyond wheezing)
UNCLEAR DIAGNOSIS
What (4) Tests should ALL patients with Shortness of Breath (SOB) receive?
- C ontinuous Oximeter
- O xygen
- C hest X-Ray (CXR)
- A rterial Blood Gas (ABG)
UNCLEAR DIAGNOSIS
What should be Performed in a patient with Shortness of Breath (SOB) and an unclear diagnosis of Asthma?
Pulmonary Function Tests both BEFORE and AFTER Inhaled Bronchodilators:
PFT Methods:
- Spirometry
- Plethysmography
PFT Measures:
- Tidal Volume (TV)
- Minute Volume (MV)
- Vital Capacity (VC)
- Functional Residual Capacity (FRC)
- Forced Expiratory Volume (FEV)
UNCLEAR DIAGNOSIS
What Pulmonary Function Test (PFT) Finding is Confirmatory for Asthma and Reactive Airway Disease in a patient currently Short of Breath (SOB)?
Increase in FEV1 of > 12% AFTER given Bronchodilators (compared to FEV1 from BEFORE given Bronchodilators)
UNCLEAR DIAGNOSIS
What Test Finding is Confirmatory for Asthma and Reactive Airway Disease in a patient who is NOT currently Short of Breath (SOB)?
Methacholine Stimulation Test
Decrease in FEV1 of > 20% AFTER give Methacholine = Asthma
Methacholine** = synthetic **Acetylcholine
TREATMENT
What are the (5) Best INITIAL Therapies for Asthma (which should be ordered with the first screen on CCS)?
-
Albuterol (inhaled bronchodilator)
- there is NO max dose.
-
Methylprednisolone (steroid bolus)
- need 4 - 6 hours to be effective.
- Ipratropium (inhaled)
- Oxygen
- Magnesium
TREATMENT
When should you place a patient with Asthma in the ICU?
Respiratory Acidosis with CO2 Retention
TREATMENT
What is Persistent Respiratory Acidosis in a patient with Asthma an indication for?
Intubation
and
Mechanical Ventilation
ACUTE ASTHMA
What are (8) Therapies that have NO Mortality Benefit for Acute Asthma?
- Theophylline
- Cromolyn and Nedocromil
- Montelukast
- Inhaled Corticosteroids
- Omalizumab (anti-IgE)
-
Salmeterol and other long-acting beta agonists (LABAs) such as Formoterol
- however, if there is an indication for BBs that decreases mortality [MI, CHF] in an asthmatic, then use the BB)
-
Epinephrine
- Subcutaneously administered epinephrine has no benefit in addition to inhaled bronchodilators.
-
Terbutaline
- less efficacious than inhaled Albuterol (Terbutaline is always a wrong answer choice).
NON-ACUTE ASTHMA
- What is the Best INITIAL Therapy for Non-Acute Asthma?
- What should you Add if the patient remains uncontrolled after the initial treatment?
- What should you Add if the patient remains uncontrolled after the two initial treatments?
- Inhaled Bronchodilator (e.g., Albuterol)
-
Inhaled Steroid (chronic controller medication)
- Beclomethasone dipropionate(Qvar)
- Budesonide (Pulmicort)
- Fluticasone (Flovent)
-
Inhaled Long-Acting Beta-Agonist (e.g., Salmeterol, Formoterol, Olodaterol, Indacaterol).
- LABAs are never to be used alone
**Oral steroids are used only as a last resort because of adverse effects.**
NON-ACUTE ASTHMA
- What is “Bronchial Thermoplasty”?
- When is Bronchial Thermoplasty used?
- Bronchial Thermoplasty = treatment of airway walls with radiofrequency energy that heats the airway and ablates the smooth muscle.
- Used when there is severe asthma despite the use of maximum medical therapy and the question describes a patient who is often or continuously on steroids.
NON-ACUTE ASTHMA
When would you use Cromolyn or Nedocromil as an alternative Long-Term Controller Therapy in an Asthmatic?
Extrinsic Allergies (e.g., Hay Fever)
NON-ACUTE ASTHMA
When would you use Montelukast as an alternative Long-Term Controller Therapy in an Asthmatic?
Atopic Disease