Approach To Asthma Flashcards

1
Q

Asthma broad overview

A

Chronic inflammatory disease of the airway due to hyper responsiveness of the airway

  • symptoms initially are variable, reversible and recurring.
  • overtime with no treatment, symptoms become irreversible and scar tissue takes over
  • smooth muscle hypertrophied and hyperplasia

Is a type 1 hypersensitivity reaction

  • type 2 helper T cells release IL-4/5
  • mast cells releases histamines, leukotrienes and prostaglandins

Causes bronchoconstriction which decreases airflow and increases resistance

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2
Q

Types of asthma

A

Atopic/ allergic asthma
- most common kind of asthma
- most are diagnosed in people before age of 7 (75%)
Most resolve by puberty

Nonatopic asthma

  • infection induced asthma
  • primarily diagnosed as adults

Drug-induced asthma

  • caused by aspirin in patients with rhinitis and nasal polyps
  • primarily diagnosed as adults

Occupational asthma

  • causes by fumes or gases
  • primarily diagnosed as adults
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3
Q

Asthma triad

A

Personal history of allergies

Eczema

Asthma symptoms

these 3 usually occur together

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4
Q

Wheezy bronchitis/ reactive airway disease

A

Found in 1-4 year old children that have wheezing due to viral URIs

  • looks like asthma, but is technically not since asthma is a chronic illness not acute
  • this resolves on its own by 5 usually, however if it doesnt then it can be considered asthma
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5
Q

History associated with asthma

A

Symptoms

  • dyspnea (especially with exertion)
  • wheezing (sometimes is audible but it is always heard on auscultation)
  • coughing (especially at night)
  • cyanosis

symptoms come in waves, hence “asthma attack”

Physical exam

  • tachypnea/tachycardia
  • possibly normal vitals in some patients
  • decreased inspiration:expiration ratio (1:2 -> 1:4) this is similar to COPD
  • wheezing can be inspiratory only, or both inspiratory and Expiratory
  • possible hyper resonance when percussing
  • substernal and intercostal retractions (stomach sucks in when breathing)
  • accessory muscle overuse (very clear to see)

NOTE: severe asthma attacks can show no wheezing on auscultation, so wheezing alone is not enough to diagnose

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6
Q

Tripod position

A

Found in patients with emphysema or severe asthma

Patients need to hunch over to breath properly

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7
Q

Pulsus paradoxus

A

Found in patients with asthma but also in a lot of other disorders

Systolic BP drops by > 10mmHg during inspiration

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8
Q

Ways to diagnosis asthma

A

1) Spirometers/PFTs are the best inital diagnostic tests to use
- is very dependent on patient effort so you must know that the patient can take orders
- FEV1 will decrease (<80% predicted)
- FEVs/FVC is decreased (<70% predicted)

2) If spirometers shows possible asthma, give SABA (albuterol) and then retest
- asthma should show symptoms improve after
- if symptoms dont improve, COPD

3) Peak flow monitoring
- note this isnt the best to diagnose asthma by itself
- very effort dependent again

4) X-rays
- shows flattening of diaphragm and increased lung volumes (however these findings just prove is some sort of obstructive disorder, not asthma entirely)

5) methacholine challenge test

6) biopsy/pathology
- shows Curschmann spirals
- muscle hypertrophy
- Charcot-Leyden crystals

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9
Q

Treatment of asthma

A

1) Avoid triggers
2) Treat underlying causes of asthma

Acute asthma attacks = SABA every 1-6 hrs and prednisone for 5-10 days

*always try to step down if possible* 
Step 1 (mild intermittent):
- just SABA 
Step 2 (mild chronic)
- prednisone 
Step 3 (moderate chronic) 
- LABA or SABA &amp; prednisone
Step 4 (severe chronic) 
- LABA + medium dose glucocorticoids
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