Asthma Flashcards
1 predisposing factor for asthma
Allergies (any)
recall: in pharm they said allergies has a genetic component to it too, so there is a slighttttt genetic component
What drug class is the mainstay for asthma? “backbone”
Inhaled Corticosteroids
two main pathophysiology components of asthma
Asthma = Inflammation + Bronchoconstriction
Asthma Exacerbation Trmnt (ABCDE…M)
A- Airway O2 Nasal Cannula
B - Bronchodilator (SABA - Albuterol)
C - Corticosteroids
D - Drinking? IV Fluids
E - Epi
M - Magnesium
If all else fails -> INTUBATION
a disease of diffuse** airway inflammation** caused by a variety of triggering stimuli resulting in partially or completely reversible bronchoconstriction
Asthma
Environmental risk factors for asthma
Allergens -> dust mites, cockroaches, pets
Diet -> low in Vit C, Vit E, Omega-3 fatty acids. Obesity
Perinatal factors -> young maternal age, poor nutrition, prematurity, low birthwight, lack of breastfeeding
Pathophys of bronchostriction in asthma
immune response -> chronically inflamed airway -> bronchial hyperreactivity -> airway remodeling
Asthma triggers that aren’t obvi commen allergens
cold, dry air
Viral infx
exercise
emotions
GERD
Sulfites in dried foods or wine
Beta blockers
Aspirin, NSAIDs
What is the one NSAID safe for asthmatics?
Celecoxib/Celebrex
Pathophys of asthma attack
Trigger → reversible airway narrowing → increased histamines, prostaglandins, leukotrienes (overreactive immune response) → CO2 trapping → hyperventilation → visible respiratory distress (accessory muscles) → hypoxemia with elevated PaCO2 → respiratory acidosis → full respiratory failure
My notes: hypoxic regions are shunted off and fluids go to other parts of the body
Wheezing that dissapears during an asthma attack means what?
they’re not moving air
Confused pt stops wheezing mid asthma attack. WDYD?
INTUBATE!
stops wheezing = no air moving
Confusion 2ndary to hypoxia (low O2) and hypercapnia (high CO2)
What is Pulsus Paradoxus?
Systolic BP drops >10mmHg when INHALING
Billman says: “bc overinflating your lungs puts pressure on your arteries -> decreases CO2”
I don’t think decr in CO2 would affect BP in this sort of pattern
Online source: “The pressure of the lungs decreases during inhalation, which is normal. A person with severe obstruction experiences an exaggerated response due to the decrease in the air pressure within the lungs, which further leads to a decrease in the systolic blood pressure”
Paradoxical = seemingly absurd or self-contradictory
Vital Signs Indicative of SEVER ASTHMA
- Pulsus Paradoxus >18 mmHg
- RR > 10
- HR > 120 bpm (Tachy)
Other: prolonged expiration (3:1 to inspiration), having to sit up to breathe, inability to speak, accessory muscle use, nasal flaring, cyanosis, loss of wheeze
Pertinent Asthma Hx Qs
How often:
symp are experiences
pt wake up at night
pt uses their SABA
asthma intereferes w/norm activity
Asthma is classified by which 3 factors?
Asthma WU
- PFT
- Spirometry
- CXR if r/o others
- Allx testing
- Peak Expiratory Flow
PFT Results
Obstructive pattern
Bronchodilator reversible
Meds to hold prior to PFT
**8 hrs for SABA (Albuterol) **
24 hrs for SAMA (Ipratropium)
12-48 hrs for Theophylline
48 hrs for LABA (Salmeterol, Formoterol)
1 wk for LAMA (Tiotropium)
Spirometry results
- DLCP (diffusing capacity for CO2) is norm or elev in asthma
- FEV1 & FEV1/FVC are reduced
DLCP is reduced in COPD. Diffusion of all gasses are reduced in COPD due to irreversible alveoli changes
Which breathing test is ordered right before and after nebulizer during asthma exacerbation
Peak Flow
- determine their baseline max expiratory effort. Then, during an exacerbation, a 15-20% reduction indicates significant exacerbation.
Asthmatic is using their SABA (Albuterol) more than 2x a week. Next step trmnt?
+ ICS
Asthmatic on SABA PRN and ICS still experiencing symptoms. Next strep trmnt?
incr ICS dose
OR
+ ICS/LABA
Cromolyn is only for ages ___
> 5yo
Meds good for asthma with an allergic component
Montelukast (Singulair) - LTRA (Leukotreine Receptor Antagonist)
Monoclonal antibodies
Albuterol SE
tremors, hypokalemia
Theophylline SE
seizures (PAs dont Rx)
Zileuton/Zyflo SE
Liver toxicity
Billman says DO NOT Rx
When to use Monoclonal Antibodies
Allergic asthma Mod-sever persistent despite ICS trmnt in pts ≥ 6 yo
Pts require a (+) skin allergen test and IgE levels prior to dosing
Asthma FU schedule
2-6 wk intervals for pts who are just starting therapy and req a set up regimen
6 month intervals after asthma is controlled, to continue monitoring
3 month intervals if step-down therapy is anticipated
When to refer out for asthma?
Referral is req at Step 4 to Asthma/Allx specialist for Pulmonology
Should asthmatics take tamiflu or relenza?
Tamiflu = GOOD; Relenza = BAD
Should asthmatics get the intranasal flu vacc or the shot?
the live attenuated intranasal flu vaccine is contraindicated -> may induce wheezing or bronchospasms
When is it okay to discharge home?
Discharge if → FEV1 or PEF post-trmnt ≥ 70% of personal best or predicted value AND if sustained improvement & stable ≥ 1hr
