asthma Flashcards
define asthma
is a chronic inflammatory disorder of the airways. The inflammation causes episodes of wheezing, breathlessness, chest tightness, and coughing. Episodes are usually associated with variable airflow obstruction that is reversible spontaneously or with treatment. The inflammation also increases existionbronchial hyperresponsiveness.
is the prevalence of asthma changing in the population?
yes it is prevalent in approximately 10% of the worlds population.
which part of the population or subgroup is demonstrating the fastest rate if increase of asthma?
all segment of the population, but the fastest growing is in children younger than 5 years old.
when comparing men and women who have asthma which group tends to have more severe asthma?
more prevalent in males but more severe in women
within the urban population which subgroup is three times more likely to suffer with asthma?
African Americans especially those in the urban areas
death rates are greatest for people with asthma under what age?
under the age of 35
patients who have experienced a life-threatening episode of asthma have been grouped in three separate subgroups, describe the 1st subgroup?
typical case- gradual deterioration over time and experiences a live threatening episode.
patients who have experienced a life-threatening episode of asthma have been grouped into three separate subgroups, describe the 2nd subgroup?
relatively mild asymptomatic chronic asthma- acute episode in a short time frame.
patients who have experienced a live-threatening episode of asthma have been grouped into three separate subgroups, describe the 3rd subgroup?
the patient who is a combination of the 1st and 2nd
what is the relationship between airway inflammation and airway hyperresponsiveness?
the airway swells on inflammation and hyperresponsiveness constrict easily and frequently.
describe in you own words “airway inflammation”?
the release of inflammatory mediators that result in wheezing, shortness of breath, chest tightness and coughing
describe in your own words “ hyperresponsiveness”?
the airway constricts too easily and frequently. factors include environmental, exercise, allergens, and viral infections.
list the factors that lead to airway obstruction?
- acute bronchoconstriction
- chronic mucus plug
- airway edema
- airway remodeling
what is the meaning of childhood asthma and atopic factors?
genetic predisposition to develop IgE response to common allergens in the environment
What is a IgE mediated response?
is an allergic asthma response the body initiates as immune response to pet dander, dust, mold, pollen (environment factors)
what is the easiest way to diagnose atopic asthma?
a skin prick test
The majority of asthmatics suffer attacks exacerbated from inhalation of an allergen. List the major indoor/ outdoor allergens?
(indoor) mold, animal dander, cleaning chemicals, cockroach antigen, dust mites
(outdoor) cold air, noxious fumes, grass and tree pollens.
what happens when a asthma trigger comes into contact with a hypersensitive airway?
causes a rupture and degranulation of mast cells, which release chemical into the bronchial tree and interact with airways smooth muscle.
what is the asthma trigger that is believed to be the major cause of asthma worldwide?
-dust mites- especially infants exposed to high concentrations in the first 3-6 months
what is the asthma trigger that is believed to be the major cause of asthma within the population of inner city dwellers?
-cockroach antigen that is inhaled by the sensitized patient
what is a device that is used in modern homes which is believed to contribute to airborne fungal growth and air contamination?
indoor humidifiers
in early spring what is the prominent asthma trigger?
trees pollen
in the fall season what is the prominent asthma trigger?
weeds, mold, alternaria and cladosporium species
( fungi or mold)
some patients have asthma attacks resulting from food and food additives, be able to list these products that can cause asthma exacerbations?
- salicylates
- food coloring agents
- food preservatives (ex: sulfites)
- monosodium glutamate
what is the relationship between viral infections in early childhood and the development of asthma?
alterations in immune system
children exposed to lower respiratory tract infections early in life, alterations in immune existed in response to viral infections
what is the most prominent viral infection that is associated with asthma later in life?
Respiratory Syncyrial Virus
( RSV )
define nocturnal asthma?
“night time asthma “
what is the relationship between nocturnal asthma and the development of asthma attacks that are more severe?
marker for uncontrolled or severe asthma
what are some of the mechanisms and variables associated with the manifestation of nocturnal asthma?
- body temp * sinusitis
- mediators *sleep apnea
- epinephrine * vagal tone
- gastroesophagel reflux * inflammation
- B2 receptor function * aspiration
- increased mucus production
- normal decrease in lung function
define exercise induced asthma?
transient airway obstruction, typically occurring 5-15 minutes after strenuous exertion.
what percentage of patients who are already diagnosed with asthma experience exercise induces asthma (EIA)?
90%
list the four etiologic theories believed to be the cause of EIA?
- heat or water loss
- mucosal drying
- rapid airway rewarming
- hyperventilation
what information is required to make a definitive diagnosis of EIA?
a fall of 10% or more in the FEV1 or in peak expiratory flow (PEF) after exercise.
typically how many minutes does it take before EIA occurs?
8-15 minutes
in the majority of cases will the symptoms of EIA spontaneously resolve over time?
yes in about 60 minutes and up to 3 hours
what pharmacologic agents should be used to prevent or treat EIA?
cromolyn sodium, nedocromil sodium or B2 agonist
sometimes a patient presents with the symptoms of EIA but response poorly to treatment further investigation may lead to a total different diagnosis such as what?
vocal cord dysfunction
what patient historical information would alert you to the existence of occupational asthma?
reports increased symptoms while at work or within several hours of the completion of a shift.
how can the diagnosis of occupational asthma be established?
monitoring peak flows in the workplace
list some of the more common chemicals known to cause occupational asthma?
- Isocyanates*
- lower molecular weight- trimellitic anhydride and formaldehyde
- high molecular weight- organic materials( grain dust, avian proteins), cigarette smoke
for a patient to fit the classification of “mild intermittent asthma” they must experience the symptoms of asthma fewer then how may times per week?
-least severe-
coughing and wheezing no more then 2 times per week
do mild intermittent asthma patients have normal PEFRs between exacerbations?
yes although exacerbations are generally brief (few hours to few days)
patients with mild intermittent asthma are expected to experience nocturnal symptoms of coughing and wheezing no more the how may times per month?
2 times per month
name two test 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?
FEV1 and PEF
the routine management of patients with mild intermittent asthma generally consist of what pharmacologic agents?
short acting B2 agonist
for the patients that fit the classification of mild persistent asthma they must experience symptoms of coughing and wheezing with in what frequency parameters?
more then 2 times per week but less than once per day
patients with mild persistent asthma generally experience nocturnal symptoms more than how may times per month?
2
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 %?
20% to 30% in PEF rates
how is the pharmacologic management of patients with mild persistent asthma different than patients with mils intermittent asthma?
mild persistent asthma need short acting B2 agonist and corticosteroid (controller)
for a patient to fit in the classification of moderate persistent asthma they must experience symptoms of coughing and wheezing within what frequency parameters?
on a near daily basis at least 2 times per week and often persist for multiple days.
patients with moderate persistent asthma generally experience nocturnal symptoms of coughing wheezing and breathlessness at what frequency?
more than once per week
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 to 80%
how is the pharmacologic management of patients with moderate persistent asthma different from patients with milder asthma?
moderate persistent asthma need short acting B2 agonist and corticosteroid on a routine of 2 to 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?
-highest level-
almost continually
frequently and persist for multiple days or weeks
patients with severe persistent asthma generally experience nocturnal symptoms coughing wheezing and breathlessness at what frequency?
almost every night
patients with severe persistent asthma generally have a measured FEV1 and PEFR which fall within the ——— zone of —-% while consistently maintaining at least a 30% variability in PEFR.
red zone
60% or less
how is the pharmacologic management of patients with severe persistent asthma different from patients with moderate asthma?
severe persistent asthma need short acting B2 agonist corticosteroid on a scheduled frequency of 2 to 3 times per day
what test can be done to determine the degree of variable airflow obstruction, hyperresponsiveness, and airflow reversibility?
pulmonary function testing (spirometry) and peak flowmeters
which spirometry test reveal airflow obstruction?
(PFT) pulmonary function test
what test can be done to determine airflow reversibility and what percentage change indicates reversibility?
PFT and 12% to 15% reversibility
Name the diagnostic tool or device used to measure static lung volumes and airway resistance?
Body plethysmography
which test is used to determine the presence of hyperinflation?
static lung volumes
how often should patients measure their peak flow readings?
daily
should a patient use a different peak flowmeter every month?
No, because variations occurs even within manufactured brand
what are the three traditional peak flow zones, include color and percentage range?
- green zone- normal zone 80-100%
- yellow zone- caution zone 80-50%
- red zone - danger zone less than 50%
what is the rationale for using the “personal best” approach for peak flow monitoring?
can determine if a patient is having a moderate to severe asthma attach by comparing personal best
