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Pulmonology > Asthma > Flashcards

Asthma Flashcards

1
Q

What is Asthma?

A

Chronic, obstructive inflammatory lung disease

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2
Q

The percentage of people in the US with Asthma is?

A

18% but its downward trending

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3
Q

Asthma is chronic _ w/ superimposed acute _ _

A

inflammation, inflammatory episodes

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4
Q

What are the three anatomic and physiologic changes that occur during long term asthma?

A

-Increase of inflammatory cells
-Hypertrophy of smooth muscle
-Basement membrane thickening

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5
Q

What causes increased intraluminal mucous accumulation?

A

Goblet cell hyperplasia

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6
Q

What is it called when there’s increased sensitivity to allergens and airway reactivity?

A

Denundation of airway epithelium

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7
Q

What are the three risk factors of asthma?

A

-Atopy
-Obesity
-Family history asthma

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8
Q

What kinds of medications act on B2-receptors?

A

Beta-adrenergic agonists

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9
Q

Name 4 SABA medications

A

Short acting B2 agonist
-Albuterol
-Levalbuterol
-Metaproterenol
-Turbutaline

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10
Q

Name 3 LABA medications

A

Long Acting B2 Agonist
-Sameterol
-Formoterol
-Arfomoterol

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11
Q

What is a side effect of prolonged use of SABA/LABA?

A

Can lead to decrease of pulmonary b2 adrenergic receptors

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12
Q

What does anticholinergics have in common with B-adrenergic agonists and how are they different?

A

-They both causes smooth muscle relaxation (bronchodilation)
-Anticholinergics reduces mucous secretions in airways

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13
Q

Name a SAMA

A

Ipratropium bromide

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14
Q

What should you give a patient with B-blocker induced asthma?

A

SAMA- ipratropium bromdie

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15
Q

Can SAMA be used with a SABA?

A

Yes, ipratropium bromide improves recovery from exacerbation when used in conjunction with SABA.

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16
Q

What’s the combination of duoneb nebulizer medication?

A

Ipratropium bromide + albuterol

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17
Q

What are 3 inhaled corticosteriods?

A

-Fluticasone
-Budesonide
-Mometasone

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18
Q

What is a good topic for patient education when prescribing inhaled corticosteroids?

A

Rinse mouth after

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19
Q

What are two inhaled corticosteroids that are mixed with a LABA?

A

Budesonide-formoterol (Symbicort)
Mometaside-formoterol (Dulera)

20
Q

What are 2 oral/injectable corticosteroids?

A

-Prednisone
-Methylprednisolone

21
Q

What would an oral or injectable corticosteroid be needed?

A

During exacerbation

22
Q

What is a leukotriene receptor antagonist and what is it for?

A

-Long term helps prevent chronic airway inflammation
- Montelukast (Singulair)

23
Q

Name a Phosphodiesterase inhibitor

A

Theophylline

24
Q

When should you prescribe theophylline?

A

For moderate or severe persistant asthma when asthma is NOT being adequately controlled by inhaled corticosteroids

25
Q

What are some actions of theophylline?

A

Antiinflammatory/immunomodullary
Enhances mucocillary clearance
Strengthens diagram contractility

26
Q

Can you prescribe theophylline for at home use?

A

No, it has a narrow window.

27
Q

What is an over the counter medication asthmatics can use?

A

Cromolyn Sodium

28
Q

What does cromolyn sodium do?

A

Mast cell inhibitor, prevents mast cell release of histamine + leuktrienes.

29
Q

How do you diagnose an asthmatic?

A

PFT at their baseline

30
Q

Where should an asthmatic’s FEV1 and FEV1/FVC be before bronchodilation?

A

Fev1 < 80%
FEV1/FVC < 85%

31
Q

After bronchodilation, how much should FVC or FEV1 improve in order to be diagnosed as asthmatic

A

=> 12% improvement

32
Q

If they test negative in the PFT are pts not asthmatics?

A

No, they still need to do a bronchoprovocation test

33
Q

How much should FEV1 be if positive test to bronchoprovocation?

A

Decrease FEV1 > 20%

34
Q

What is the medication used in bronchoprovocation test?

A

methacholine

35
Q

What is PEF?

A

Peak expiratory flow measurement, its a quick measurement of forced expiration following full inspiration used to monitor during treatment

36
Q

What are the three zones for PEF?

A

Green zone -80-100%
Yellow zone- 50-80%
(start home action plan, avoid stimuli)
Red zone - <50%
(serious airway obstruction- medical emergency)

37
Q

What are three validated questionnaires to identify asthma?

A

ATAQ: Asthma therapy assessment questionnaire
ACQ: Asthma control questionnaire
ACT: Asthma control test

38
Q

What are the 5 guidelines for treatment according toe the 2022 Global strategy for asthma management and prevention?

A
  1. Assessing asthma control and severity
  2. Distinguish between severe asthma and uncontrolled asthma
  3. Personalize pharmacologic therapy
  4. Treat modifiable risk factors
  5. Self-management education and skills training
39
Q

What are the 4 questions of GINA asthma symptom control?

A
  • Daytime asthma symptoms more than 2/week
    -Any night waking due to asthma
    -SABA reliever for symptoms more than 2/week
    -Any activity limitation due to asthma

Well controlled = 0
1-2 Partially controlled
3-4 Uncontrolled

40
Q

What is STEP I in GINA and medications they can take?

A

Symptoms < 2x times a month

Low-dose ICS with rapid onset LABA
Budesonide-formoterol
Mometasone-formoterol

or

Low-dose ICS whenever SABA used.

Budesonide
Mometasone
Fluticasone

Albuterol/levalbuterol/Terbutaline/Metaproterenol

41
Q

What is STEP II and medication they can take?

A

Symptoms < 4 days per week

Low-dose ICS with + LABA as needed
Budesonide-formoterol
Mometasone-formoterol

or

Low-dose ICS DAILY + SABA used.

Budesonide
Mometasone
Fluticasone

Albuterol/levalbuterol/Terbutaline/Metaproterenol

42
Q

What is STEP III and medication they can take?

A

Symptoms 4-6 days per week or waking once a week:

Low-dose ICS-LABA as maintenance and reliever therapy
budesonide-formoterol
Mometason-formoterol

Low-dos ICS-LABA combination daily with SABA as needed

budesonide-formoterol
Mometason-formoterol +
Albuterol/levalbuterol/Terbutaline/Metaproterenol

Consider specialist

43
Q

What is STEP IV and medication they should take?

A

Daily symptoms or waking with asthma once per week or more

Medium-dose ICS-LABA daily and SABA as needed

budesonide-formoterol
Mometason-formoterol +
Albuterol/levalbuterol/Terbutaline/Metaproterenol

Leukotriene receptor antagonist (Montelukast)
or
LAMA- tiotropium

Refer to specialist

44
Q

What is STEP V and medication they should take

A

High dose ICS-LABA daily and SABA as needed

*Leukotriene receptor antagonist, LAMA-tiotriopium or oral glucocorticoids.

ONLY Mometasone-formoterol

45
Q

What is a short term step up?

A

1-2 weeks during seasonal pollen or viral illness increased

46
Q

What is a sustained step up?

A

2-3 months
Continued symptoms at current level with confirmed diagnosis of asthma
if no responses in 2-3 months, reduce to previous level and try alternative treatments/refer.

47
Q

What is step down?

A

Attempt to step down to previous tier if symptoms are well controlled for 2-3 months.

Pulmonology (14 decks)

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