Asthma Flashcards
What is the definition of asthma?
Chronic inflammatory disorder of the airways. In susceptible patients, it causes wheezing, breathlessness, coughing, and chest tightness. Air flow is often reversible with treatment
Is the prevalence of asthma changing in the population?
Yes, it is rapidly increasing
Which part of the population or subgroup is demonstrating the fastest rate of increase of asthma?
Children younger than 5 years of age
When comparing men and women who have asthma which group tends to have more severe asthma?
Women
Within the urban population which subgroup is three times more likely to suffer with asthma?
African Americans
Death rates are greatest for people with asthma under what age?
35 years old
Patients who have experienced a life-threatening episode of asthma have been grouped into three separate subgroups, describe these subgroups.
a) typical case, a patient who presents with a gradual deterioration over time and experience a life threatening episode
b) patient with relatively mild, asymptomatic chronic asthma and suffers an acute episode in a relatively short time frame
c) patient who is a combination of the previous two cases
What is “acute asphyxia asthma”?
Patient with relatively mild, asymptomatic chronic asthma and suffers an acute episode in a relatively short time frame is known as asphyxia asthma
The pathophysiology of asthma is related to what three characteristics?
Inflammation, hyperresponsiveness and obstruction
What is the relationship between airway inflammation and airway Hyperresponsiveness?
Over time recurrent episodes of airway inflammation results in an increase in hyperresponsiveness
Be able to describe in your own words “airway inflammation”.
A trigger sets off the inflammatory mediators, which results in exacerbations such as wheezing, shortness of breath, chest tightness and coughing. It can be acute, subacute or chronic. Inflammation can lead to hyperresponsiveness and can also result in airflow limitation
Be able to describe in your own words “airway hyperresponsiveness”.
The airways constrict easily and often, and is usually determined by the severity of the disease. Many factors affect hypersensitivity such as the environment, exercise and viral infections.
Utilize figure 46-1 as a visual aid that relates inflammation, airway hyperresponsiveness, and airflow limitation.
Some kind of trigger sets off chronic inflammation, which in turn triggers the symptoms of asthma, airflow limitation and increases hyperresponsiveness
List the factors that lead to airway obstruction (see box 46-2, page 900)
Acute bronchoconstriction, chronic mucus plug formation, airway edema and airway remodeling
Asthma in childhood is normally linked to atopic factors. What is the meaning of the statement?
Familial or genetic predisposition to develop a response to common allergens in the environment
What is an IgE mediated response?
Asthma caused by an allergy or antigen
What is the easiest way to diagnose atopic asthma?
Skin prick testing
The majority of asthmatics suffer attacks exacerbated from inhalation of an allergen. List the major indoor and outdoor allergens.
Indoor: mold, pet dander, cleaning chemicals, cock roach antigen and dust mites
Outdoor: cold air, noxious fumes, grass and tree pollen
What happens when a “asthma trigger” comes into contact with a hypersensitive airway?
It causes a rupture and degranulation of the mast cell
What is the “asthma trigger” that is believed to be the major cause of asthma worldwide?
Dust mites
What is the “asthma trigger” that is believed to be the major cause of asthma within the population of inner city dwellers?
Cock roach antigen
What is a device that is used in modern homes which is believed to contribute to airborne fungal growth and air contamination?
Home humidifiers
In early spring what is the prominent “asthma trigger”?
Trees
In the fall season what is the prominent “asthma trigger”?
Weeds
Some patients have asthma attacks resulting from food and food additives, be able to list these products that can cause asthma exacerbations.
Salicylates, some food coloring agents, food preservatives (sulfites) and monosodium glutamate
What is the relationship between viral infections in early childhood and the development of asthma?
The inflammatory response to viral infections may start the cascade of symptomatic wheezing from inflammatory debris or excessive mucus production in the airways
What is the most prominent viral infection that is associated with asthma later in life?
RSV (retro syncytial virus)
Define nocturnal asthma.
Night time symptoms of asthma
What is the relationship between nocturnal asthma and the development of asthma attacks that or more severe ?
The presence of nocturnal asthma is a marker for uncontrolled or more sever asthma
What are some of the mechanisms and variables associated with the manifestation of nocturnal asthma?
Circadian alterations of body temp, vagal tone, mediator, inflammation, epinephrine and B2 receptor function. Other potential variables include gastroesphogeal reflux, aspiration, sinusitis, increased mucus production, sleep apnea and normal decrease in lung functions of patients sleeping
Define exercise-induced asthma.
Characterized by transient airway obstruction, typically occurs 5-15 minutes after strenuous exertion
What percentage of patients who are already diagnosed with asthma experience EIA?
90%
List of the four etiologic theories believed to be the cause of EIA.
- respiratory heat or water loss (or both) from bronchial mucosa
- mucosal drying increased osmolarity stimulation mast cell degranulation
- rapid airway rewarming after exercise, causing vascular congestion, increased permeability and edema leading to obstruction
- hypoventilation, causing discharge of bronchospastic chemical mediators
What information is required to make a definitive diagnosis of EIA?
a fall of 10% or more in the FEV or in peak expiratory flow (PEF) rate after exercise in diagnostic
Typically, how many minutes does it take before EIA occurs?
peak at 8-15 minutes
In the majority of cases will the symptoms of EIA spontaneously resolve over time?
yes, after 60 minutes
What pharmacologic agents should be used to prevent or treat EIA?
Cromolyn sodium nedocromil sodium, inhaled B2 agonists
Sometimes a patient presents with the symptoms of EIA but responds poorly to treatment. Further investigation may lead to a totally different diagnosis, such as ______________
Vocal cord dysfunction
What patient historical information would alert you to the existence of occupational asthma ?
Variable airway hyperresponsiveness in the workplace
How can the diagnosis of occupational asthma be established ?
Monitoring peak flows in the work place
List some of the more common chemicals known to cause occupational asthma.
Trimellitic anhydrate, formaldehyde, grain dust, avian proteins and cigarette smoking
For a patient to fit the classification of mild intermittent asthma, they must experience the symptoms of asthma (coughing and wheezing) fewer than how many times per week?
Two
Do these patients have normal PEFRs between exacerbations?
Yes
Patients with mild intermittent asthma are expected to experience nocturnal symptoms of coughing and wheezing no more than ____ times per month.
Two
Name two tests that should fall consistently in the “green zone” or be at least 80% of predicted while maintaining less than 20% variability for patients with mild intermittent asthma.
Measure FEV or PEF
The routine management of patients with mild intermittent asthma generally consists of what pharmacologic agents?
Short acting B-agonist
For a patient to fit the classification of mild persistent asthma they must experience symptoms of coughing and wheezing within what frequency parameters?
More than two times per week but less than once per day
Patients with mild persistent asthma generally experience nocturnal symptoms more than _____ times per month.
Two
All patients with mild persistent asthma should have measured FEV1 and PEFRs consistently in the green zone or at least 80% of predicted, however, the level of variability of these measurements is increased to what percentage?
20-30% variability of PEF rates
How is the pharmacologic management of patients with mild persistent asthma different than patients with mild intermittent asthma?
Long acting inhaled or oral B2 agonist or oral sustained released theophylline
For a patient to fit the classification of moderate persistent asthma they must experience symptoms of coughing and wheezing within what frequency parameters?
Near daily basis
Patients with moderate persistent asthma generally experience nocturnal symptoms of coughing wheezing and breathlessness at what frequency?
At least two times per week and often persist for multiple days
Patients with moderate persistent asthma generally have a measured FEV1 and PEFR which fall within the yellow zone of ___% to ___ % while consistently maintaining at least a 30% variability in PEFR.
60-80%
How is the pharmacologic management of patients with moderate persistent asthma different from patients with milder asthma ?
A short acting B2 agonist for exacerbations and inhaled corticosteroid on a routine frequency of 2-3 times per day
For a patient to fit the classification of Severe Persistent Asthma they must experience symptoms of coughing and wheezing within what frequency parameters?
Almost continually
Patients with Severe Persistent Asthma generally experience nocturnal symptoms of coughing wheezing and breathlessness at what frequency?
Almost every night
How is the pharmacologic management of patients with Severe Persistent Asthma different from patients with moderate asthma?
Chronic oral corticosteroids, long acting inhaled bronchodilator and inhaled corticosteroid 2-3 times daily
What tests can be done to determine the degree of variable airflow obstruction, hyperresponsiveness, and airflow reverseability?
Lung volumes and RAW, exhaled nitric oxide, pulmonary function testing, spirometry and peak flow meters
Patients with Severe Persistent Asthma generally have a measured FEV1 and PEFR which fall within the _______ zone of ___% to ___ % while consistently maintaining at least a 30% variability in PEFR.
Red, 60%, less
What tests can be done to determine airflow reverseability and what percentage change indicates reverseability?
Pre and post bronchodilator testing; 12-15%
Name the diagnostic tool or device used to measure static lung volumes and airway resistance.
Body plethysmography
Which spirometry tests reveal airflow obstruction?
Normal or slightly decreased vital capacity, decreased or normal FEV1, decreased/normal PEF and decreased FEV/FVC
How often should patients measure their peak flow readings?
Daily
Should a patient use a different peak flowmeter every month?
No, a patient should use a specific device of consistent readings
Which test is used to determine the presence of hyperinflation?
Static lung volumes
What is the rationale for using the “personal best” approach for peak flow monitoring ?
Most people with moderate/severe asthma can’t reach the green zone on their best days
Exhaled nitric oxide has been indicated as a useful marker of airway inflammation. What are the reasons why it is not currently being applied as a clinical monitoring technique?
There are standardization issues of measurement techniques for exhaled nitric oxide analysis- contamination by nasal nitric oxide and variable expiratory flow rates
What are the three traditional peak flow zones, include color and percentage range?
Green zone: predicted or personal best, 80-100%
Yellow zone: predicted or personal 50-80%
Red zone: less than 50%
