Asthma Flashcards
asthma
reversible, often intermittent, obstructive disease or the small airways
pathophysiology of asthma
airway inflammation, airway hyperactivity, bronchoconstriction
what type of hypersensitivity reaction is asthma
type 1 hypersensitivity rxn
RF for asthma
atopy strongest risk factor
FHx
pollution
obesity
environmental tobacco smoke
male
sx asthma
episodic dyspnea
wheezing
cough (especially at night)
may have chest tightness or fatigue
PE for asthma
wheezing and/or prolonged expiratory phase during normal breathing due to presence of airflow obstruction, hyper resonance to percussion, decreased breath sounds, tachycardia, tachypnea, use of accessory muscles
when is wheezing most prominent in asthma
during expiration
severe asthma and status asthmaticus
inability to speak ion full sentences, “tripod” positioning, silent chest, altered mental status, pulses paradoxes (inspiratory BP drop > 10
what is the best and most objective way to assess acute exacerbation severity and patient response to tx in asthma
peak expiratory flow rate
what percent for peak expiroatry flow rate indicates tx response in asthma
PEFR > 15%
what PEFR value indicates respiratory distress in asthma
PEFR < 200 L/min
what might ABG show during mild exacerbation
respiratory alkalosis from tachypnea
what indicates need for mechanical ventilation in asthma
pseudo normalization of the PaCO2 or the combination of an increased PaCO2 and respiratory acidosis may indicate impending respiratory failure
are chest radiographs helpful in the diagnosis of asthma
no
airflow obstruction in asthma
decreased FEV1
Decreased FEV1/FVC <0.7
increased lung volumes due to hyperinflation: increased residual volume (RV), total lung capacity (TLC), and RV/TLC
significant reversibility in asthma
increase in 12% or more and 200 mL in FEV1 or FVC after inhaling a short-acting bronchodilator
what test can you do for asthma when asthma is suspected but baseline spirometry is normal or non diagnostic
bronchial provocation with Methacholine or Histamine
what will bronchial provocation testing show for asthma
a decrease in FEV1 20% or greater after exposure to methacholine
intermittent asthma
sx 2 or fewer times per week
2 or fewer awakenings due to sx per month
use of SABA two or fewer times per week
no interference with normal activity
tx for intermittent asthma
short-acting beta-agonist as needed
mild persistent asthma
sx > 2 times per week (but not daily)
3-4 episodes of night awakenings due to sx per month
use of SABA more than 2 times per week (but not daily and not more than once per day)
minor limitations to daily activity
tx for mild persistent asthma
low dose inhaled corticosteroids
short acting beta agonist as needed
moderate persistent asthma
sx daily
night awakenings due to sx at least once per week (but not nightly)
use of SABA on daily basis
some limitations in daily activity
tx moderate persistent asthma
low dose inhaled corticosteroids plus long acting beta agonist or a medium dose inhaled corticosteroid plus a long acting beta agonist
short acting beta agonist as needed
severe persistant asthma
sx daily
night awakenings every night
use of SABA multiple times per day
extreme limitations in daily activity
tx severe persistent asthma
medium or high dose inhaled corticosteroid and a long-acting beta agonist plus LAMA and oral system corticosteroids
short acting beta agonists
albuterol
levalbuterol
Terbutaline
Epinephrine
ADE short acting beta agonists
tachycardia
arrhythmias
muscle tremors
CNS stimulation
hypokalemia
anticholinergics (SAMA/LAMA)
Ipratropium
Aclidinium
Glycopyrrolate
Revefenacin
Tiotropium
Umeclidinium
anticholinergics ADE
thirst
blurred vision (pupil dilation)
dry mouth
urinary retention
dysphagia
glaucoma
BPH
corticosteroids
Prednisone
Methylprednisolone
Prednisolone
ADE corticosteroids
immunosuppression
catabolic
hyperglycemia
fluid retention
osteoporosis
growth delays
inhaled corticosteroids
beclomethasone
Flunisolide
Triamcinolone
ADE inhaled corticosteroids
oral candidiasis
dysphonia
long acting beta agonists
Salmeterol
ICS/LABA: Budesonide/Formoterol, Fluticasone/Salmeterol
mast cell modifiers
Cromolyn
Nedocromil
minimal side effects
Leukotriene modifiers/receptor antagonists
Montelukast
Zafirlukast
Zileuton
minimal side effects
ADE Theophylline
nervousness
N/V
Anorexia
HA
Narrow TI: toxicity causes arrhythmias and seizures
acute bronchitis
self-limited lower respiratory tract infection causing inflammation of the large airways
most common cause of acute bronchitis
respiratory virus - Influenza A and B, parainfluenza virus, respiratory syncytial virus, coronavirus, adenovirus, rhinovirus
bacterial causes of acute bronchitis
s pneumonia
h influenza
m catarrhalis
mycoplasma pneumoniae
chalmydia pneumoniae
bordetella pertussis
when does acute bronchitis commonly occur
during winter months
sx acute bronchitis
cough is hallmark - acute and persistent (1-3 weeks); initially nonproductive but later a productive cough with sputum may develop. presence of sputum is nonspecific.
URI sx - runny nose, sore throat, low grade fever, malaise, sore throat, HA, myalgias, fever — fever is rare in acute bronchitis
wheezing or mild dyspnea
PE for acute bronchitis
often normal but both wheezing and honcho may be auscultated on PE
honcho usually clear with coughing
dx acute bronchitis
clinical - acute onset of persistent cough (1-3 weeks) + no findings suggestive of pneumonia (fever, tachypnea, rales, hypoxia, or signs of parenchymal consolidation, such as dullness to percussion, decreased or bronchial breath sounds, rales, ego phony)
chest radiographs for acute bronchitis
not needed - usually normal or nonspecific.
indicated when acute bronchitis cannot be distinguished from pneumonia
tx acute bronchitis
self limited
tx for cough in bronchitis
guaifenasin
dextromethorphan
benzonatate
codeine
FEV1 and FCV for intermittent asthma
FEV1 > 80% of predicted
normal FEV1/FVC
FEV1 and FVC in mild persistent asthma
FEV1 > 80% predicted
normal FEV1/FVC
FEV1 and FVC in moderate persistent asthma
FEV1 60-80% predicted
FEV1/FVC reduced by < 5%
FEV1 and FVC in severe persistent asthma
FEV1 < 60
FEV1/FVC reduced by > 5%
