(4.1) Asthma in a Nutshell [DSA-Newman] Flashcards
Describe the “practice gap” that most likely contributes to the high number of asthma-related urgent care visits?
There is a lack of universal implementation of asthma guidelines in clinical practice
What is the hygiene hypothesis?
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
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)
A clean enviornment is MORE likely to push the immune system toward an allergic phenotype
Therefore, they are MORE likely to develop asthma
Define:
Asthma
“A disease of the airways with inflammation, constriction of airway smooth muscles, mucous production, and edema that lead to obstruction and air trapping”
What are the clinical symptoms of asthma?
Cough
Wheezing
Chest tightness
Prolonged exhalation
SOA
_____________ 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.
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.
What drug is frequently associated with asthma exacerbation?
Aspirin
In addition to viral respiratory tract infections and aspirin, what are some other common triggers for asthma?
- Exercise
- Weather changes
- Tobacco/smoke
- Air pollution
- Strong perfumes
Why is it challenging to diagnose asthma?
There is NO SIMPLE TEST to confirm the diagnosis when most patients first present
What is the asthma predictive index?
This index was developed to improve the accuracy of diagnosis of asthma in children younger than 3yo
What is the most common method used to measure airflow obstruction?
Spirometry
T/F
A normal spirometry result rules out asthma
FALSE!!!
When can peak-flow meters be useful?
Adjusting long-term maintenance therapy
Wet and productive cough is typically an indication of?
Chronic bronchiectasis
The sudden onset of symptoms with persistence of cough and wheeze may indicate?
Foreign body aspiration
Coughing and choking with feedings are suggestive of?
Dysphagia and Aspiration
A hx of 2 or more pneumonias raises the possibility of?
Underlying immunodeficiency
What is a fairly common but frequently overlooked diagnosis that can mimic asthma?
Vocal cord dysfunction
Define:
Vocal cord dysfunction
Involuntary closure of the vocal cords during exercise
What is the typical patient description with vocal cord dysfunction?
Teenager with competitive personality who excels in academics and sports
Define:
Exercise-induced asthma
Symptoms start within a few minutes of vigorous exercise and typically subside within 20-30 min
What is the gold standard for diagnosis of exercise induced asthma?
A greater than 10% decreased in FEV1 compared with preexercise level
Once asthma has been established as a likely diagnosis, what is the NEXT STEP?
Determine it’s severity
What two factors does a physician need to take into consideration when determining the best treatment approach?
Impairment
and
Risk
What is impairment?
The frequency and severity of asthma symptoms and their effect on a pts life
What does risk refer to?
- A hx. of asthma
- Severity of exacerbations
- Ability to access urgent care
- Need for oral systemic steriods
(Pharm)
Most asthmatic children will do well with…
A metered-dose inhaler
and
A spacer
At each follow up visit with a asthmatic pediatric pt., what (6) things should be addressed?
- Asthma control
- Enviornmental triggers
- Treatment adjusted
- Inhaler technique reviewed
- Concerns addressed
- Goals set
What (4) critical things do families with asthmatic children need to learn?
- How to correctly give daily maintenance medication
- How to detect and respond to fluctuations in asthma control
- Knowing when to seek professional help
- When to go to the emergency department
What is an asthma action plan?
Written care instructions to family that are personalized to the patient’s asthma type
How long do SABAs typically last?
3 to 4 hours
How long do LABAs typically last?
12 hours
What are common side effects of B2 agonists?
Agitation
Irritability
Tremor
Insomnia
Tachycardia
Arrhythmia
What is the most commonly prescribed maintenance therapy for asthma?
ICS
What is the net effect of ICS?
Suppression of inflammation
What is one of the more common side effects associated with ICS?
Oral thrush
What is a benefit of Leukotriene antagonists?
Easy to administer…they are an ORAL medication
What is the RAD Score?
A score that can estimate the severity of asthma
R = Respiratory rate
A = Accessory muscle use
D = Decreased breath sounds
What are RED FLAG warning signs of a severe asthma attack?
- Lethargy
- Pallor/cyanosis
- Severe retractions
- Prolonged exhalation
- Inability to speak
- Poor air movement
