(4.1) Asthma in a Nutshell [DSA-Newman]

Question 1

Describe the “practice gap” that most likely contributes to the high number of asthma-related urgent care visits?

Answer 1

There is a lack of universal implementation of asthma guidelines in clinical practice

Question 2

What is the hygiene hypothesis?

Answer 2

Exposure to bacteria and endotoxin at a young age influences the development of the immune system

Therefore, has a protective effect against the development of asthma

Question 3

Is a child that grows up in a “clean enviornment” more or less likely to develop asthma?

(based on postulated theories of the epidemiology of asthma)

Answer 3

A clean enviornment is MORE likely to push the immune system toward an allergic phenotype

Therefore, they are MORE likely to develop asthma

Question 4

Define:

Asthma

Answer 4

“A disease of the airways with inflammation, constriction of airway smooth muscles, mucous production, and edema that lead to obstruction and air trapping”

Question 5

What are the clinical symptoms of asthma?

Answer 5

Cough

Wheezing

Chest tightness

Prolonged exhalation

SOA

Question 6

_____________ are a major trigger for asthma exacerbations in a large number of patients, which explains the seasonal increase in asthma exacerbations during the winter months.

Answer 6

VIRAL RESPIRATORY TRACT INFECTIONS are a major trigger for asthma exacerbations in a large number of patients, which explains the seasonal increase in asthma exacerbations during the winter months.

Question 7

What drug is frequently associated with asthma exacerbation?

Answer 7

Aspirin

Question 8

In addition to viral respiratory tract infections and aspirin, what are some other common triggers for asthma?

Answer 8

• Exercise
• Weather changes
• Tobacco/smoke
• Air pollution
• Strong perfumes

Question 9

Why is it challenging to diagnose asthma?

Answer 9

There is NO SIMPLE TEST to confirm the diagnosis when most patients first present

Question 10

What is the asthma predictive index?

Answer 10

This index was developed to improve the accuracy of diagnosis of asthma in children younger than 3yo

Question 11

What is the most common method used to measure airflow obstruction?

Answer 11

Spirometry

Question 12

T/F

A normal spirometry result rules out asthma

Answer 12

FALSE!!!

Question 13

When can peak-flow meters be useful?

Answer 13

Adjusting long-term maintenance therapy

Question 14

Wet and productive cough is typically an indication of?

Answer 14

Chronic bronchiectasis

Question 15

The sudden onset of symptoms with persistence of cough and wheeze may indicate?

Answer 15

Foreign body aspiration

Question 16

Coughing and choking with feedings are suggestive of?

Answer 16

Dysphagia and Aspiration

Question 17

A hx of 2 or more pneumonias raises the possibility of?

Answer 17

Underlying immunodeficiency

Question 18

What is a fairly common but frequently overlooked diagnosis that can mimic asthma?

Answer 18

Vocal cord dysfunction

Question 19

Define:

Vocal cord dysfunction

Answer 19

Involuntary closure of the vocal cords during exercise

Question 20

What is the typical patient description with vocal cord dysfunction?

Answer 20

Teenager with competitive personality who excels in academics and sports

Question 21

Define:

Exercise-induced asthma

Answer 21

Symptoms start within a few minutes of vigorous exercise and typically subside within 20-30 min

Question 22

What is the gold standard for diagnosis of exercise induced asthma?

Answer 22

A greater than 10% decreased in FEV1 compared with preexercise level

Question 23

Once asthma has been established as a likely diagnosis, what is the NEXT STEP?

Answer 23

Determine it’s severity

Question 24

What two factors does a physician need to take into consideration when determining the best treatment approach?

Answer 24

Impairment

and

Risk

Question 25

What is impairment?

Answer 25

The frequency and severity of asthma symptoms and their effect on a pts life

Question 26

What does risk refer to?

Answer 26

• A hx. of asthma
• Severity of exacerbations
• Ability to access urgent care
• Need for oral systemic steriods

Question 27

(Pharm)

Most asthmatic children will do well with…

Answer 27

A metered-dose inhaler

and

A spacer

Question 28

At each follow up visit with a asthmatic pediatric pt., what (6) things should be addressed?

Answer 28

1. Asthma control
2. Enviornmental triggers
3. Treatment adjusted
4. Inhaler technique reviewed
5. Concerns addressed
6. Goals set

Question 29

What (4) critical things do families with asthmatic children need to learn?

Answer 29

1. How to correctly give daily maintenance medication
2. How to detect and respond to fluctuations in asthma control
3. Knowing when to seek professional help
4. When to go to the emergency department

Question 30

What is an asthma action plan?

Answer 30

Written care instructions to family that are personalized to the patient’s asthma type

Question 31

How long do SABAs typically last?

Answer 31

3 to 4 hours

Question 32

How long do LABAs typically last?

Answer 32

12 hours

Question 33

What are common side effects of B2 agonists?

Answer 33

Agitation

Irritability

Tremor

Insomnia

Tachycardia

Arrhythmia

Question 34

What is the most commonly prescribed maintenance therapy for asthma?

Answer 34

ICS

Question 35

What is the net effect of ICS?

Answer 35

Suppression of inflammation

Question 36

What is one of the more common side effects associated with ICS?

Answer 36

Oral thrush

Question 37

What is a benefit of Leukotriene antagonists?

Answer 37

Easy to administer…they are an ORAL medication

Question 38

What is the RAD Score?

Answer 38

A score that can estimate the severity of asthma

R = Respiratory rate

A = Accessory muscle use

D = Decreased breath sounds

Question 39

What are RED FLAG warning signs of a severe asthma attack?

Answer 39

• Lethargy
• Pallor/cyanosis
• Severe retractions
• Prolonged exhalation
• Inability to speak
• Poor air movement

Question 40