Asthma Flashcards
Essentials of DX for what issue
(1) Episodic or chronic symptoms of wheezing, dyspnea, or cough.
(2) Symptoms frequently worse at night or in the early morning.
(3) Prolonged expiration and diffuse wheezes on physical examination.
(4) Limitation of airflow on pulmonary function testing or positive Broncho provocation challenge.
(5) Reversibility of airflow obstruction, either spontaneously or following bronchodilator therapy.
Asthma
Asthma is a common disease, affecting approximately what % of the population?
8–10%
It is slightly more common in what demographics?
male children (younger than 14 years) female adults
What is a chronic disorder of the airways characterized by variable airway obstruction, airway hyperresponsiveness, and airway inflammation
Asthma
What is the most common phenotype of asthma?
Allergic
True/false
Allergic asthma usually begins in childhood and is associated with other allergic diseases such as eczema, allergic rhinitis, or food allergy
True
What is characterized by episodic wheezing, shortness of breath, chest tightness, and cough.
Asthma
During severe asthma exacerbations, airflow may be too limited to produce wheezing, and the only diagnostic clue on auscultation may be _____________.
globally reduced breath sounds with prolonged expiration.
(normal/abnormal)
Arterial blood gas (ABG) measurement may be _______ during a mild asthma attack
normal
Ture/False
Respiratory alkalosis and an decrease in the alveolar-arterial oxygen difference (A–a–DO2) are common
False
INCREASE in alveolar arterial oxygen difference
During severe ASTHMA exacerbations,
______ develops and the PaCO2 returns to normal.
hypoxemia
CXR’s on asthma usually show what
usually normal or show only hyperinflation
may include bronchial wall thickening and
diminished peripheral lung vascular shadows
when is chest imaging indicated for asthma
pneumonia
another disorder mimicking asthma
a complication such as pneumothorax is suspected
The combination of an increased PaCO2 and respiratory acidosis may indicate what
impending respiratory failure
VENTALATE THAT MOFO
What are the five important aspects of chronic asthma management?
(a) Assessing asthma control and severity,
(b) Distinguishing between severe asthma and uncontrolled asthma,
(c) Personalized pharmacologic therapy for asthma,
(d) Treatment of modifiable risk factors and control of environmental factors
(e) Guided self-management education and skills training
Most asthma medications are administered by what two routes.
inhalation or by oral dosing
What is the first line therapy for asthma management?
Inhaled corticosteroids
All patients who have asthma must have access to what class of medication?
Shot acting Beta-agonists
SABAs
What are some examples of SABAs?
ALBUTEROL levalbuterol bitolterol pirbuterol terbutaline
What are the mainstays of reliever or rescue therapy
for asthma patients
SABA’s
Beta-agonists are divided into what sub classes
SABA’s- Short acting
LABA’s -Long acting
Treatment of exacerbations:
What is the action to take if your patient has a poor reaction to a SABA, IE PEF < 50% predicted or
personal best and have symptoms of respiratory distress
refer to emergency room/evac
Your pt has exacerbation with some minor changes in airway function, PEF greater than 60% of their best and minimal signs of airway dysfunction.
Is this Mild/severe?
What would be effective to use for this reaction?
Mild exacerbation
SABA alone may show quick response
Severe exacerbations of asthma can be life threatening, so treatment should be started _________.
Immediately
Severe Exacerbations:
Early initiation of WHAT type of therapy is paramount because asphyxia is a common cause of asthma deaths
oxygen therapy
All patients with a severe exacerbation should immediately receive what?
Oxygen, high doses of an inhaled SABA, and systemic corticosteroids.
________ are most effective in achieving prompt control of asthma during acute exacerbations
Systemic corticosteroids
What are the examples of corticosteroids
prednisone
prednisolone
parenteral methylprednisolone
Severe Exacerbations:
Supplemental oxygen should be given to maintain a SaO2 greater than __% or a PaO2 greater than __ mm Hg.
SaO2 >90%
PaO2 >60 mm Hg
What is STEP 2 in the approach to the management of Asthma
Daily Low dose ICS
Carry SABA
What is STEP 3 in the approach to the management of Asthma
Low-dose ICS- LABA
What is STEP 4 in the approach to the management of Asthma
Medium dose ICS - LABA
What is STEP 5 in the approach to the management of Asthma
High dose ICS - LABA
These issues with asthma; what is the action to take
1) Atypical presentation or uncertain diagnosis of asthma, particularly if additional diagnostic testing is required (bronchoprovocation challenge, allergy skin testing, rhinoscopy, consideration of occupational exposure).
2) Complicating comorbid problems, such as rhinosinusitis, tobacco use, multiple environmental allergies, suspected allergic bronchopulmonary mycosis.
3) Occupational asthma.
4) Uncontrolled symptoms despite a moderate-dose inhaled corticosteroid and a LABA.
REFER
Refer?
Patient not meeting goals of asthma therapy after 3–6 months of treatment.
Yes
Can an idc manage this patient?
- Frequent asthma-related healthcare utilization.
- More than two courses of oral prednisone therapy in the past 12 months.
- Presence of social or psychological issues interfering with asthma management.
No refer
