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Allergy/Immunology > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Inflammation and bronchoconstriction causing airway issues.

Mucous production also worsens the obstruction

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2
Q

Airway hyperresponsiveness

A

Exaggerated bronchoconstriction response to stimuli

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3
Q

Airway edema

A

Edema, mucous production, formation of thickened mucous plugs.

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4
Q

Patient hx suggesting asthma?

A

Symptoms that occur w/ exposure to triggers, and resolve with avoidance of trigger.

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5
Q

Symptoms of asthma

A

Cough
End-expiratory wheezing
SOB
Symptoms may be seasonal or diurinal

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6
Q

Pathophysiology of Asthma

A
  1. Eosinophils promote airway hyper-responsiveness.
  2. Lymphocytes produce cytokines and leukotrienes.
  3. Mast cells arouse IgE receptors.
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7
Q

The fundamental problem with asthma is ____, NOT _____

A

AIrway inflammation, not bronchospasm

Bronchospasm arises from airway inflammation

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8
Q

Asthma triad

A

Wheezing
Chronic episodic dyspnea
Chronic cough

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9
Q

Associated symptoms of asthma

A 
Tachypnea, tachycardia, HTN
Harsh respirations, wheezing
Sputum production
Chest pain/tightness
Diminished breath sounds
Sometimes only happens at night
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10
Q

Dx of asthma

A
  1. Hx of asthma symptoms
  2. S/S suggestive of asthma
  3. Confirmation with spirometry
  4. Exclusion of other diagnoses
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11
Q

Spirometry

A
  • Order before and after bronchodilators
  • Can also have pt monitor at home.
  • Positive bronchodilator response is when test is better after application of bronchodilator
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12
Q

Which blood test would you use to dx asthma?

A
  1. There are no blood tests for asthma. IgE may be increased, but this is not necessary to diagnose asthma.
  2. May want to R/O anemia
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13
Q

Bronchoprovocation test

A

Or metacholine test

Inspiration of known trigger to induce a response

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14
Q

Extrinsic Asthma

A

Atopic Asthma

  1. Initiated by type I hypersensitivity.
    - Most common
    - generally occurs in first 2 decades of life.
    - associated w/ other allergic manifestations
    - IgE and eosinophil counts are usually elevated
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15
Q

Most common causes of cough.

A
  1. GERD
  2. Post nasal drip
  3. asthma
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16
Q

6 questions to assess degree of asthma control.

A
  1. Have you taken oral glucocorticoids to asthma in the past year?
  2. Have you been hospitalized/intubated form asthma in the last year?
  3. How many ED visits for asthma in the last year?
  4. Do you smoke?
  5. Any increase in S/S after ASA/NSAIDS?
  6. What is your normal peak flow?
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17
Q

Peak flow Green zone

A

80-100% of the pt’s normal peak flow signals all clear.

Asthma is under control

18
Q

Peak flow yellow zone

A
  1. 50-80% of the normal peak flow signals caution.
  2. patient may require extra treatment
  3. Have a plan for yellow zone readings
19
Q

Peak flow red zone

A

Less than 50% of normal.
Immediate actions need to be taken.
Take rescue medications right away

20
Q

Beta-2 agonists stimulate ______ ______ receptors.

A

Beta-androgenic

21
Q

Beta-2 agonists

A
  • Produce airway dilation.

- Can be long or short acting

22
Q

Short-acting beta-2 agonist

A
  • Albuterol, Proventil, Ventolin
  • Most widely-used beta-agonist
  • Rescue medication
  • Quick onset, lasts 4-6 hours
23
Q

Increasing albuterol use to one canister or 200 puffs/month signals?

A
  • Lack of adequate asthma control

- More frequent use=more adverse SE

24
Q

Adverse effects of beta-2 agonists

A
  • tachycardia
  • tremor
  • hypokalemia
  • HA
  • Hyperglycemia
  • Increased lactic acid
25
Q

Long-acting beta-2 agonist

A

Salmeterol (Serevent)
Formoterol (Foradil)
NOT rescue drugs … used for long-term effects

26
Q

MOA of long-acting Beta-2

A 
Slower onset (30 mins)
Longer lasting (9-12 hrs)
27
Q

Non-selective beta agonists

A 
Not recommended for asthma
-Epinephrine (emergent use)
-Isoproterenol
-Metrapel
-Loetharine
Many adverse cardiac SE
28
Q

Ipratropium Bromide (atrovent)

A
  • May enhance bronchodilation
  • Use in combination w/ beta-agonist
  • Slow to act (60-90 mins)
  • Synergistic with albuterol
  • Minimal SE
29
Q

Tiotropium (Spiriva)

A 
Same profile as Ipatropium Bromide
Longer acting (24 hrs)
30
Q

Theophylline

A

Out of favor, but still in guidelines
Methylxanthine bronchodilator
IV or oral

31
Q

Corticosteroids

A
  • Fluticonase (flonase) and others
  • Anti-inflammatory: reduces airway inflammation
  • Can be used with acute (IV) or chronic illness
32
Q

Inhaled steroids

A
  • Reduces airway reactivity
  • Start in any patient who is not controlled by bronchodilators
  • Alternative to oral glutocorticoids
  • 2-4 weeks produce beneficial effect
33
Q

Corticosteroid SE

A
  • Thrush
  • Dysphonia (voice problems)
  • Adrenal suppression, cataracts
34
Q

Budesonide

A

First nebulized corticosteroid

35
Q

PO steroids

A

Such as methyprednisolone can be used

36
Q

Advair

A

Purple. Combo of fluticasone, salmeterol

37
Q

Combivent

A

Orange and green. Combo of ipratropium and albuterol

38
Q

Cromolyn (Intal) and Nedocromil (Tilade)

A
  • Do not influence airway tone
  • Inhibit degranulation of mast cells
  • Prevent allergy rxn
39
Q

Singulair

A

Leukotriene inhibitor
Anti-inflammatory
May have increased suicide rate

40
Q

Anti-IgE antibodies

A

Xolair
Inhibits binding of IgE to mast cells
Prescribed by allergist

41
Q

Asthma Triad (NSAID one)

A

Asthma, nasal polyps and NSAID allergy

Allergy/Immunology (10 decks)

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