Asthma Flashcards
Definition of Asthma?
Chronic, variable inflammatory disorder of the airways resulting in reversible hyper-responsive inflammation
What are some of the Symptoms of Asthma?
- Dyspnea
- Chest Tightness
- Cough (often worse at night or early morning)
- Wheeze
- Sputum Production
- Activity limitations: fatigue earlier
What are you like to see on an Asthmatic’s Physical Exam?
Mild Symptoms:
- Wheeze
- Prolonged Expiration
- Signs of Atopy
Severe Symptoms:
- Tachypnea
- decreased breath sounds
- accessory muscle use
History questions to ask an Asthmatic?
- *Past Medical History:**
- allergic rhinitis
- atopic dermatitis
- allergic conjunctivitis
- *Family History**
- asthma
- *Timing of Symptoms**
- day vs night
Triggers
Asthma Triggers? (8)
- Cold Air
- Exercise
- Viral Illness
- Allergen (mould, pollens, dander, peanut, seafood)
- Irritant (smoking, fuel, occupation-related)
- Food (sulphites, MSG, cold drinks)
- Meds (beta blockers, NSAIDs, aspirin)
- Strong Emotions
Differential Diagnosis of Asthma?
- Central airway obstruction
- parenchymal lung disease
- COPD
- bronchiectasis
- alpha 1- antitrypsin deficiency
- Pulmonary embolism
- Heart failure
- Congenital heart disease
- Medication related cough (ex ACEi)
- Vocal cord dysfunction
- GERD
- Foreign body
- Tracheomalacia
- Postnasal drip (chronic upper airway cough syndrome)
- Cystic fibrosis
- Recurrent viral respiratory tract infection
- Exercise induced bronchoconstnction
Non-pharmacological management
- Encourage aerobic exercise
- Strongly encourage smoking cessation
- Consider avoiding NSAIDs (10-20% are sensitive to NSAIDs / aspirin) and non-cardioselective betablockers
- Avoiding all allergens and environmental triggers is unrealistic
- If risk of anaphylaxis, ensure auto-renewable prescription of epi-pen
- Consider annual influenza vaccination
How do you diagnose Asthma?
CLINICAL HISTORY COMPATIBLE WITH ASTHMA
Paroxysmal or persistent symptoms such as dyspnea, chest tightness, wheezing, sputum production, and cough
and
CONFIRMATION OF REVERSIBLE AIRFLOW OBSTRUCTION
How can we confirm airflow obstruction in Asthma is reversible? (Preferred)
Adults (18+)
Spirometry showing reversible airflow obstruction
FEV1/FVC < LLN (<0.75-0.8)
AND
increase in FEV1 after a bronchodilator or after a course of controller therapy of ≥12% and a minimum of ≥200mL
Children (6+)
Spirometry showing reversible airflow obstruction
FEV1/FVC < LLN (<0.8-0.9)
AND
increase in FEV1 after a bronchodilator or after a course of controller therapy of ≥12%
Children (1-5 years)
Documentation by trained health care provider of wheeze and other signs of airflow obstruction with documented improvement with SABA +/- oral corticosteroids
How can we confirm airflow obstruction in Asthma is reversible? (Alternative)
Adults (18+)
Peak expiratory flow: 60L/min (minimum ≥20%) increase after a bronchodilator or after a course of controller
therapy
OR
Diurnal variation >8% based on twice daily
readings; >20% based on multiple daily readings
Children (6+)
Peak expiratory flow: ≥20% increase after a bronchodilator or after a course of controller therapy
Children (1-5 years)
Convincing caregiver report of wheezing or other symptoms of airflow obstruction with symptomatic
response to a 3-month trial of a medium dose of ICS and as needed SABA or symptomatic response to SABA
What should you regularly reassess with Asthma patients?
- Control
- Risk of exacerbation
- Spirometry or PEF
- Inhaler technique
- Adherence
- Triggers
- Comorbidities
What is Well-Controlled Asthma?
- Daytime Symptoms: ≤ 2 days/week
- Nighttime Symptoms: < 1 night/week and mild
- Physical activity: Normal
- Exacerbations: Mild and infrequent
- Absence from School/Work: None
- Need for reliever: ≤ 2 doses per week
- FEV1 or PEF: ≥ 90% of personal best
- PEF diurnal variations: < 10-15%
- Sputum eosinophils: < 2-3%
Patient who meets all of the above criteria would be considered to have well-controlled asthma.
A mild exacerbation is an increase in asthma symptoms from baseline that does not require systemic steroids, an ED visit, or a
hospitalization
Acute Asthma Management in Peds?
http://pedscases.com/sites/default/files/Acute%20Asthma%20Exacerbation%20pg2_0.jpg
How to interperet a Methacholine challenge?
What is Asthma action plan?
An Asthma Action Plan is a written, individualized worksheet that shows you the steps to take to keep your asthma from getting worse. It also provides guidance on when to call your healthcare provider or when to go to the emergency room.
Treatment approach for patients on PRN SABA or no medication?
Athma Ladder?
(just to remember the image)
