Asthma Flashcards
what is asthma?
how is PFT used? what are the measurements
asthma: an inflammatory condition of the airway due to a hyperimmune response in which the over-inflammatory response creates airway obstruction (obstructive airway disease
PFT: we care a lot about spirometry for astham
- FVC: forced vital capacity is the max exhalation from max inhaltion
- FEV1: the volume of air which can be forced out in 1 second
**normal FEV1 should be 80% or greater than the pts. personal best or 80% or greater than the expected value (in asthma this will be less)
the key here is that with asthma this will be reversible by 12% with the addition of a bronchodilator
FEV1/FVC ratio: normally this is within 5% of predicted
PEF: peak expiratory flow rate is the max speed a pt. can blow out
- done at home iwth peak flow meter (do 3x and record best and compare as the control
what is exercise induced bronchospasm? (EIB) symptoms, diagnosis, and treatment
symptoms: cough, SOB, chest pain/tightness, wheezing after or during exercise
diagnosis: a 15% decrease in FEV1 or PEF with an exercise challenge after measurements every 20-30 mins
treatment: can be pre-treated prior to exercise
long-term controller inhaler if its consistent or severe sx.
pre-treat with SABA or low-ICS/fomoterol combo PRN for sx..
leukotriene can help in 50%
what are the goals of asthma therapy? (big picture)
4 components of asthma care?
GOALS
- reduce the impairment ( prevent chronic sx., reduce need for SABA rescue, maintain good lung function and normal activity)
- reduce their risk ( reduce exacerbations, hospitalizations, loss of lung function, minial side effects)
COMPONENTS OF CARE
- asses and monitor severity of asthma
- educate!!!
- control co-morbidities and environmental factors
- medication management
alwasy ensure proper inhaler technique and know the different between rescue and maitnence inhaler
at first visits– assess severity of asthma
youre at the first visit with your asthma pt. (12+ years) using the big chart you have identify their risk —> and put them in a proper “treatment” category based on EPR-3 guidelines
what is the medication treatment based on the group?
THIS IS FOR INITIAL TREATMENT!!! not management
(all pt. needs a rescue SABA inhaler of some sort)
Step 1: as needed SABA
Step 2: daily low-dose ICS + their resuce SABA (or a combo PRN ICS/SABA)
Step 3: daily AND PRN low-dose ICS/fomoterol
Step 4: daily and PRN medium-dose ICS/fomoterol
Step 5: daily medium-high dose ICS/LAMA/LABA + resuce
Step 6: daily hig-dose ICS/LABA + OCS + resuce
youre at the first visit with your asthma pt. (12+ years) using the big chart you have identify their risk —> and put them in a proper “treatment” category based on GINA guidelines
what is the medication treatment based on the group?
GINA: everyone ahs a rescue inhaler as: PRN low-dose ICS/fomoterol
step 1&2: PRN low-dose ICS/fomoterol
step 3: daily low-dose ICS/fomoterol
step 4: daily medium -dose ICS/fomoterol
step 5: daily high-dose ICS/fomoterol + LAMA (or immunologic)`
what are the different types of aerosol delivery devices?
- metered dose inhalers (MDI)
– shake inhaler, breathe in slowly as you adminsiter, wait 10 seconds then repeat with 1min between & rinse if ICS - soft-mist inhalers (SMIs)
- dry powder inhaler (DPIs) –> doesnt have the propelling agent like MDI
- nebulizer think severe exacerbations
- space/chamber holder: helps with the timing of push & inhale
what are pt. factors which you need to consider to determine what type of asthma device youre to use?
- physical ability (deterosity, eye/hand coordination)
- adult v child
- device specific factors
what are pt. factors which you need to consider to determine what type of asthma device youre to use?
- physical ability (deterosity, eye/hand coordination)
- adult v child
- device specific factors
Beta-adrenergic agonists
- MOA
- types for asthma
- names for each type
- ADE
- warnings/contraindications
Beta agonists: work by bronchodilating
MOA: relax smooth muscles in the bronchioles, increased cAMP to dilate
can be helpful in EIB
Types: Long and Short Acting
Short Acting: albuterol & levalbuterol –> think of as the rescue inhaler
- time to onset of action: 1-5 minutes
- shorter onset, but shorter duration of action
Long Acting: Formoterol & Salmeterol –> longer onset
- formoterol: time to onset: 5 minutes–> why its used in combo because its short time to work & lasts12 hours
- salmetreol: time to onset: 15-20 minutes –> lasts 12 hours
Side Effects (see these? thing bad management)
- tachycardia
- tremor, HA, dizzy
- dysarrythmias
- HYPOkalemia
- HYPERglycemia
Warnings
- LABA cannot be used monotherapy –> increased risk of death (salmeterol) and increased exacerbations (fomoterol) –> MUST BE USED IN COMBO
- tolerance of these drugs is possible
corticosteroids
- MOA
- types for asthma
- onset of action between types
- names of some ICS
- names and indication for oral
- Side effects
corticosteroids: backbone of asthma treatment!!! becuase its an inflammatory process
MOA: potent anti-inflammatory
- reduce airway inflammation, hyperresponsiveness, reduce secretions and prevent EIB
Types
- ICS
- oral (for exacerbations and severe asthma)
Indications
-ICS: more safe & less systemic effects –onset of action 1-2 weeks with max 4-8 weeks
- systemic: “burst” of meds to control during deterioration (like 3-10 day supply)
Names
- ICS: beclomethasone, budesonide, flunisolide, fluticosone, momentasone
- oral: prednisone, methylprenisolone
Side Effects
- loacl: oral thrus rinse mouth , reflex cough/bronchospasm, dysphona
- systemic: HPA suppression, thin skin, HTN, cushing’s, osteoperosis
anti-cholenergic (muscarinic) medications
- MOA
- types for asthma
- names
- indication for use
- side effects
muscarinic antagonists!!!! are anticholenergic
MOA: competitive inhibitor of the muscarinic receptor – which promotes dilation of bronchi (ruduces vagal tone)
Types: Short and Long Acting
Short: Ipatropium bromide (Atrovent)
- used as add-on therapy during severe asthma (ED)
- used for those whoe cant take SABA
Long: Tiotropium (Spiriva)
- 12 years and older ONLY
- used as maitence treatment (for those in like severe classes)
Side Effects – anti-cholenergic (so they mimic sympathetic)
- dry mouth
- URI
- sinusitis
- blurry vision (in eyes)
- tachycardia & palps
anti-cholenergic (muscarinic) medications
- MOA
- types for asthma
- names
- indication for use
- side effects
muscarinic antagonists!!!! are anticholenergic
MOA: competitive inhibitor of the muscarinic receptor – which promotes dilation of bronchi (ruduces vagal tone)
Types: Short and Long Acting
Short: Ipatropium bromide (Atrovent)
- used as add-on therapy during severe asthma (ED)
- used for those whoe cant take SABA
Long: Tiotropium (Spiriva)
- 12 years and older ONLY
- used as maitence treatment (for those in like severe classes)
Side Effects – anti-cholenergic (so they mimic sympathetic)
- dry mouth
- URI
- sinusitis
- blurry vision (in eyes)
- tachycardia & palps
leukotriene modifiers
- MOA
- names
- indications
- side effects
MOA: anti-inflammatory
- leukotriene antagonist to decrease inflammation in airway OR
- 5-lipoxy. pathway to decrease production of leukotrienes
Names
- Montaleukast : anyone 1+ years (mono= 1!!)
- Zafirlukast: 7+ years
- Zileuton: 12+ years
indications
- good for EIB
Side Effects
- HA, N/GI upset
- neuropsych. events -monoleuko: mental health
- ** Z’s = hepatic dysfunction
Mast Cell Stabilizer
- MOA
- Name
- Side Effects
MOA: anti-inflammatory & EIB use
name
- Cromolyn Sodium
Side Effects
- cough, bronchospams
Methylxanthines
- MOA
- Name
- Side Effects
MOA: mild inhibition of bronchospams & anti-inflammatory
Name
- theophylline
Side Effects (lots)
- high levels: CNS stimulation, seizures, cardiac stimulation, hematoemisis
- normal levels: insomina, GI issues, hyperactive, prostate issues in older men
** THEOPHYLLINE NEEDS TO BE SERUM MONITORED 5-15 HENCE WHY IT ISNT USED**
