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PTHER 544 - Cardiorespiratory > 20. Asthma > Flashcards

20. Asthma Flashcards

1
Q

Clinical diagnosis

A

no gold standard diagnostic criteria; diagnosed on the basis of exclusion

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2
Q

Diagnosis

A

basis of exclusion with presence of:

  • wheeze, breathlessness, chest tightness, cough
  • variable airflow obstruction
  • recent airway hyper responsiveness
  • airway inflammation induced
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3
Q

Children diagnosis

A
  • intermittent cough + wheeze
  • exercise induced symptoms

** only 1/4 children with symptoms actually have asthma

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4
Q

Using diagnostic tests

A
  • combination of S&S more predictive

- isolated diagnostic test/S&S has poor predictive value

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5
Q

Spirometry - what is it used for? diagnosis with spirometry?

A
  • identify airflow obstruction

- diagnosis: demonstration of airflow variability over short period of time

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6
Q

Spirometry - asymptomatic asthma

A
  • normal spirometry
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7
Q

Spirometry - indication of asthma

A

obstructive spirometry with positive bronchodilator reversibility increases probability of asthma

  • if normal, record PEF at home when symptomatic
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8
Q

Tests for airway inflammation

A
  • evidence supporting is not strong
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9
Q

Diagnosis

A
  • history of episodic symptoms triggered by viral infection or allergen exposure
  • exacerbated by cold air, exercise, emotions/stress
  • wheeze, chest tightness, dyspnea, cough
  • children: Obese/overweight kids 50% of diagnosis
  • adults: symptoms triggered by NSAIDs or Beta Blockers
  • symptoms worse at night or early AM
  • lower FEV1 or PEF during episodes
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10
Q

Asthma vs. COPD

  • Age
  • Smoking
  • Sputum
  • Allergies
  • Clinical Symptoms
  • Disease course
  • Co-morbidity
  • Spirometry
  • Airway inflammation
  • Response to corticosteroids
A
  • Age:
  • Smoking
  • Sputum
  • Allergies
  • Clinical Symptoms
  • Disease course
  • Co-morbidity
  • Spirometry
  • Airway inflammation
  • Response to corticosteroids
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11
Q

Asthma Management

A
  • Education, PAAP
  • Reduce visit to ER/hospital admission
  • improve control, symptoms, work absence, QOL
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12
Q

PAAP

A
  • recognize asthma control assessed by symptoms or peak flow

- 2 or 3 action points if symptoms deteriorate (seek emergency, increased inhaled/oral corticosteroids)

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13
Q

Allergen avoidance

A
  • house dust (chemical, heat, vacuum)
  • pet dander (potent provoker)
  • smoke (in teens increase risk of persistent asthma)
  • air poluution (smog, air quality)
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14
Q

Breathing exercise

A

behaviour modification:

  • breathing exercises
  • dysfunctional breathing reduction
  • reduce bronchodilator usage
  • little to no effect on lung function (does not improve lung function when episodic)
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15
Q

Physiotherapy

A
  • focus on calm, diaphragmatic breathing
  • breathing exercises
  • inspiratory muscle training
  • airway clearance techniques
  • cardiopulmonary fitness
  • medication
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16
Q

Exercise

A
  • no changes to PEF, FEV 1 or FVC
  • improve cardiovascular fitness and work capacity
  • incorporate as part of overall wellness
17
Q

Papworth method: breathing training - functional breathing

A
  1. Eliminate dysfunctional breathing (e.g. hyperinflation, hyperventilation patterns; prevent yawning)
  2. Replace use of inappropriate accessory muscles of reparation
  3. Emphasis on calm slow nasal expiration (nose breathing > mouth breathing)
  4. Reduce habits such as yawning, sighing
18
Q

Papworth method: Breathing exercises - general education

A
  • educate: recognition and physical management of stress responses and interaction with breathing patterns
  • relaxation training
  • breathing & relaxation techniques into ADL (teach in semi-recumbent, to sitting, to standing, and then during daily activities/speach)
19
Q

Pharmacological management: medications (COPD vs. Asthma)

A

Asthma = short acting (rescue) = corticosteroids (and beta agonists when required)

** know the classes of drugs used to manage

20
Q

Pharmacological management: what are we aiming to control?

A
  1. no daytime symptoms
  2. no night time awakening
  3. no need for rescue meds
  4. no attacks
  5. no functional limitations including exercise
  6. normal lung function, minimal side effects
21
Q

Pharmacological management: asthma controlled vs. uncontrolled

A

Controlled:

  • Environment control, education, action plan
  • SABA
  • ICS
Uncontrolled:
(Environment control, education, action plan; SABA; ICS)
- LABA 
- LTRA, 
- Prednisone

PTHER 544 - Cardiorespiratory (12 decks)

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