Asthma Flashcards
What is Asthma?
Chronic, obstructive inflammatory lung disease
The percentage of people in the US with Asthma is?
18% but its downward trending
Asthma is chronic _ w/ superimposed acute _ _
inflammation, inflammatory episodes
What are the three anatomic and physiologic changes that occur during long term asthma?
-Increase of inflammatory cells
-Hypertrophy of smooth muscle
-Basement membrane thickening
What causes increased intraluminal mucous accumulation?
Goblet cell hyperplasia
What is it called when there’s increased sensitivity to allergens and airway reactivity?
Denundation of airway epithelium
What are the three risk factors of asthma?
-Atopy
-Obesity
-Family history asthma
What kinds of medications act on B2-receptors?
Beta-adrenergic agonists
Name 4 SABA medications
Short acting B2 agonist
-Albuterol
-Levalbuterol
-Metaproterenol
-Turbutaline
Name 3 LABA medications
Long Acting B2 Agonist
-Sameterol
-Formoterol
-Arfomoterol
What is a side effect of prolonged use of SABA/LABA?
Can lead to decrease of pulmonary b2 adrenergic receptors
What does anticholinergics have in common with B-adrenergic agonists and how are they different?
-They both causes smooth muscle relaxation (bronchodilation)
-Anticholinergics reduces mucous secretions in airways
Name a SAMA
Ipratropium bromide
What should you give a patient with B-blocker induced asthma?
SAMA- ipratropium bromdie
Can SAMA be used with a SABA?
Yes, ipratropium bromide improves recovery from exacerbation when used in conjunction with SABA.
What’s the combination of duoneb nebulizer medication?
Ipratropium bromide + albuterol
What are 3 inhaled corticosteriods?
-Fluticasone
-Budesonide
-Mometasone
What is a good topic for patient education when prescribing inhaled corticosteroids?
Rinse mouth after
What are two inhaled corticosteroids that are mixed with a LABA?
Budesonide-formoterol (Symbicort)
Mometaside-formoterol (Dulera)
What are 2 oral/injectable corticosteroids?
-Prednisone
-Methylprednisolone
What would an oral or injectable corticosteroid be needed?
During exacerbation
What is a leukotriene receptor antagonist and what is it for?
-Long term helps prevent chronic airway inflammation
- Montelukast (Singulair)
Name a Phosphodiesterase inhibitor
Theophylline
When should you prescribe theophylline?
For moderate or severe persistant asthma when asthma is NOT being adequately controlled by inhaled corticosteroids
What are some actions of theophylline?
Antiinflammatory/immunomodullary
Enhances mucocillary clearance
Strengthens diagram contractility
Can you prescribe theophylline for at home use?
No, it has a narrow window.
What is an over the counter medication asthmatics can use?
Cromolyn Sodium
What does cromolyn sodium do?
Mast cell inhibitor, prevents mast cell release of histamine + leuktrienes.
How do you diagnose an asthmatic?
PFT at their baseline
Where should an asthmatic’s FEV1 and FEV1/FVC be before bronchodilation?
Fev1 < 80%
FEV1/FVC < 85%
After bronchodilation, how much should FVC or FEV1 improve in order to be diagnosed as asthmatic
=> 12% improvement
If they test negative in the PFT are pts not asthmatics?
No, they still need to do a bronchoprovocation test
How much should FEV1 be if positive test to bronchoprovocation?
Decrease FEV1 > 20%
What is the medication used in bronchoprovocation test?
methacholine
What is PEF?
Peak expiratory flow measurement, its a quick measurement of forced expiration following full inspiration used to monitor during treatment
What are the three zones for PEF?
Green zone -80-100%
Yellow zone- 50-80%
(start home action plan, avoid stimuli)
Red zone - <50%
(serious airway obstruction- medical emergency)
What are three validated questionnaires to identify asthma?
ATAQ: Asthma therapy assessment questionnaire
ACQ: Asthma control questionnaire
ACT: Asthma control test
What are the 5 guidelines for treatment according toe the 2022 Global strategy for asthma management and prevention?
- Assessing asthma control and severity
- Distinguish between severe asthma and uncontrolled asthma
- Personalize pharmacologic therapy
- Treat modifiable risk factors
- Self-management education and skills training
What are the 4 questions of GINA asthma symptom control?
- 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
What is STEP I in GINA and medications they can take?
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
What is STEP II and medication they can take?
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
What is STEP III and medication they can take?
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
What is STEP IV and medication they should take?
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
What is STEP V and medication they should take
High dose ICS-LABA daily and SABA as needed
*Leukotriene receptor antagonist, LAMA-tiotriopium or oral glucocorticoids.
ONLY Mometasone-formoterol
What is a short term step up?
1-2 weeks during seasonal pollen or viral illness increased
What is a sustained step up?
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.
What is step down?
Attempt to step down to previous tier if symptoms are well controlled for 2-3 months.
