Asthma Flashcards
Pathophysiology of Asthma
bronchospasm: causes air trapping
inflammation: causes the bronchial lumina to become edematous
bronchial lumina produces increased amounts of thick mucus
Four Components of Asthma Care
- Assessment and monitoring of asthma severity and control
- Education for a partnership in care
- Control of environmental factors and co-morbid conditions that affect asthma
- Medications
New Assessment
Identification of phenotypes
Pattern of inflammation
- eosinophilic
- neutrophilic
- determine if it’s allergic eosinophilic disease - T2 inflammation factor (increased exhaled FeNO, eosinophil count, IgE level)
- EOS > 400 cell/u associated with increased rates of severe exacerbation and decreased rate of control
- asthma is a heterogeneous condition
Assessment and Management of Asthma Severity and Control
- monitor the s/sx of asthma
- spirometry recommended for pts 5YO+
- PCP seeing pt at least every 2-6wks until control is achieved
- chronic asthma visits
referral to asthma specialist if:
- required hospitalization or 2 rounds of oral prednisone
- not reaching goal tx in 3-6 months
- co-morbidities that complicate asthma (nasal polyps)
- additional diagnostic testing
Goals of Asthma Tx
- ensure asthma is in good control
- normal or almost normal pulmonary function
- be able to participate in a normal activity level
- prevent exacerbations of asthma
- provide optimal pharmacological therapy w/ minimal side effects
Asthma Action Plan
Green Zone: Go
-breathing is easy, no cough/wheeze, can work and play, can sleep at night
Yellow Zone: Caution
-cough or mild wheeze, tight chest, SOB, problems working or playing, problems sleeping (cough which wake person up at night)
Red Zone: Emergency
- very short of breath
- medicine not helping
- breathing is fast and hard, nose wide open, ribs showing
- can’t talk well
- lips or fingernails are grey/blue
Rules of Two
persistent symptoms are not OK
- any persistent symptoms for more than 2x a week
- awakened by asthma symptoms more than 2x/month
- using more than 2 canisters of quick acting relief med in a year
then management is inadequate
Co-Morbid Conditions that may Affect Asthma
- GER
- chronic stress and/or depression
- obesity or over-weight
- OSA
- rhinitis/sinusitis
Meds to Tx Asthma
Quick relief: used in acute episodes
-short acting beta2agonists
Long-Term Control: reduces inflammation, relax airway muscles, improve sx and lung function
- inhaled corticosteroids
- long acting beta2agonists (LABA)
- Leukotriene modifiers
Anticholinergics:
-bronchodilators used in addition to short acting beta2agonists when needed or as an alternative (Atrovent)
Systemic Corticosteroids:
-anti-inflammatory used in emergency to get rapid control of sx when initiating other medications and to speed recovery (prednisone)
Spacers
Nebulizers:
- used for small children or for severe asthma episodes
- no evidence that it is more effective than an inhaler used with a spacer
Biological Therapy
for tx of severe allergic asthma:
- Omalizumab (Anti-IgE) - for ages 6+
- Mepolzumab, benralizumab (Anti-IL5) - for age 12+
- moving towards a personalized approach to asthma management
Diagnosis - characterize subtype
-phenotype, endotype, associated comorbidities, then determine targeted therapy
ICU Care of Asthma
IV theophylline (aminophylline)
- watch for toxicity
- therapeutic range = 10-20
Discharge Teaching for Asthma
- Use of spacer and peak flow
- Medications
- Annual flu shot
- f/u appointments
- Asthma Action Plan
