Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med IIB Pulmonology > Asthma > Flashcards

Asthma Flashcards

1
Q

What is the biggest difference between acute bronchitis/pneumonia and asthma?

A

Asthma has thickening of bronchioles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is asthma?

A

Chronic inflammation with exacerbations is a REVERSIBLE lung disease that has triggers that stimulate it

-infections
-colds
-chemicals

any irritant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What causes asthma?

A

Not a single factor

But there is eosinophils (also sometimes neutrophils and T-lymphocytes)
-goblet cell hyperplasia
-increased mucous leads to plugging of airway
-inflammation

All of these lead to airway edema and mast cell activation leading to hyper-reposniveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes hypersensitivity and what is the hypersensitivity

A

Antigens
Leading to bronchoconstrition and inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the factors that cause asthma?

A

Environmental factors (more allergens)
Genetic factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the strongest identifiable predisposing factor for asthma?

A

Atopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is atopy?

A

combination of runny nose, allergy like symptom, rash, eczema

if eczema and runny nose, they will likely have asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the risk factors for asthma?

A

Obesity
Respiratory irritants
Pollutants (2nd hand smoke)
Environment
Weather (often cold)
GERD
Virus
Exercise-induced
Beta-blockers
Stress
Aspirin
NSAIDs
Family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When does asthma begin?

A

1-5 years MC (51.4%)

77% <5 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the types of asthma?

A

Extrinsic (allergic)
Intrinsic (something inside)
Mixed
Occupational
Drug-induced
Exercise induced
Cough variant (after ruling things out, improved with bronchodilator)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the diagnostic approach that you start with for asthma?

A

Clinical suspicion
History
PE with s/s of allergies (wheezing, eczema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you confirm dx of asthma?

A
  • PFT (spirometry) typically at 5

perhaps allergy testing
sometimes just try bronchodilator and see if it works

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the s/s of asthma

A

Dry hacking cough
Wheezing
Chest tightness
SOB
Episodic wheezing with virus/cold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the PE of asthma?

A

Increased nasal secretion
Mucosal swelling
Nasal polyps
Wheezing or just prolonged expiratory
Use of accessory muscles
Silent chest (no air movement at all)
Mild, severe,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do you focus on for PE of lung exam

A
  1. Inspection
    Shape
    Hyperinflated - severe asthma
    Movement of chest
    Silent - life threatening
    Retractions?
  2. Palpation
    Normal chest expansion may be reduced (hyperinflated)
    Tactile fremitus - may be decreased
  3. Percussion
    Normal to Hyperresonant
  4. Auscultation
    Rhonchi to wheeze (usually expiratory but may be inspiratory as well)
    Prolonged expiratory phase
    Silent chest - severe asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the diagnostic testing of choice for asthma, and what are the criteria?

A

Spirometry shows reduced FEV1/FVC < 70% in adult < 85% in adult

Bronchodilator trial: FEV1 OR FVC improves by 12% for kids (just need one) and adults need 200 mL as well (it is reversible)

REVERSIBILITY IS SEEN IN ASTHMA, not COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If you are not able to catch asthma on spirometry, what can you do?

A

Bronchoprovocation test (induce an asthma attack with histamines, needs to have greater than 65% FEV1 otherwise dmg)

exercise test
peak flow measures
CXR (typically normal though)

Skin allergen testing
Measure sputum for eosinophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why would you order a CXR for asthma?

A

Undiagnosed
Low yield in acute asthma exacerbation (abnormal after repeat)

Status asthmaticus or no improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What do you see in CXR for asthma?

A

MC = nothing
Sometimes hyperinflation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do you see on labs for asthma?

A

ABGs may show hyoxemia, hypercarbia
CBC = eosinphilia
Sputum: casts, thick sputum, Curschmann’s spirals and Charcot-Leyden crystals (both only seen in asthma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a methacholine challenge test?

A

Breathe in excessive methacholine and perform spirometry after each dose

If we see decrease >20% in FEV1 up to 16 mg/mL max dose

very expensive though, very rare, very dangerous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Differences in asthma and COPD

A

Onset: asthma = early, COPD = late
s/s: asthma = vary from day/day based on exposure COPD = slowly progressing symptoms
Allergy, family history, reversible
COPD is not reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a golden rule of asthma?

A

Not all wheezes = asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are some complications of asthma?

A

Exhaustion
Dehydration
Airway infection
Pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

After a diagnostic of asthma, what do you do next?

A

Determine severity
Development of treatment plan
Educate on how to use dilator
Close monitoring of patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

To stage asthma, what are important questions to ask?

A
  1. How many days a week do you have symptoms?
  2. How many times a month do you wake up from attacks?
  3. How is your life effected between exacerbations?
  4. Have you required oral steroids

Should test for FEV1 measurements and FEV1/FVC ratio at every visit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is mild intermittent asthma?

A

Daytime asthma symptoms occurring ≤ 2 or fewer days per week
≤ 2 night awakenings per month
Use of SABA/rescue inhaler fewer than 2 times per week
No interference with normal activities between exacerbations (not missing activities)
FEV1 measurements between exacerbations are consistently within normal range (≥ 80% predicted value)
FEV1/FVC ratio between exacerbations that is normal
0-1 exacerbations requiring oral glucocorticoids per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is mild persistent asthma?

A

Symptoms more than 2 weekly (although less than daily)
Approximately 3-4 night-time awakenings per month due to asthma (but fewer than every week)
Use of SABA to relieve symptoms more than 2 times a week (but not daily)
Minor interference with normal activities
FEV1 measurements within normal range and normal FEV1/FVC ratio
2 or more exacerbations requiring oral glucocorticoids per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is moderate persistent asthma?

A

Daily symptoms of asthma
Nighttime awakenings more than once per week
Daily need for SABA for symptom relief
Some limitation in normal activity
FEV1 between 60-80% of predicted and FEV1/FVC below normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is severe persistent asthma?

A

Symptoms of asthma throughout the day
Night-time awakenings nightly
Need for SABA for symptom relief several times per day
Extreme limitation in normal activity
FEV1 ≤ 60% predicted and FEV1/FEC below normal

31
Q

What are the goals of asthma treatment?

A
  1. Minimal or no chronic symptoms in the day, night, or after exertion
  2. Minimal to no exacerbations
  3. No limitations on activities
  4. Maintain near normal pulmonary function
  5. Minimal use of rescue inhaler (less than or equal to 2 times a week)
  6. Minimal or no adverse effects of medications
32
Q

What are the pharm treatments for asthma?

A

Short-Acting Beta-Agonist (SABA)
Inhaled Corticosteroids
Long-acting Beta Agonist (LABA)
Combined Agents
Inhaled Anticholinergics
Theophylline
Leukotrienes
Miscellaneous (Cromolyn)
Racemic Epinephrine
Monoclonal Antibodies

33
Q

What are SABAs vs LABAs used for?

A

SABAs = relievers
LABAs = preventers

34
Q

What pharm should every asthmatic have?

A

SABA

Albuterol
Levalbuterol

known as rescue inhalers
relaxes smooth muscles

-everyone asthmatic needs this!!!

35
Q

What is the difference between albuterol and levabuterol

A

levalbuterol = no cardiac problems, but they are more expensive

36
Q

What are the SE of SABAs?

A

Tachycardia
Nervousness
Shakiness

Less SE with levalbuterol though

37
Q

What are the inhaled corticosteroids used for in asthma? How much should you percribe?

A

Preferred long-term controller

Prescribe the lowest dose possible

38
Q

What are the common inhaled corticosteroids for asthma? Which is also in a nebulize form?

A

Pulmicort (only one in nebulize solution, perferred in preggo)
Qvar
Asmanex
Flovent

39
Q

What is the MOA of inhaled corticosteroids for asthma

A

Reduces airway inflammation and reduces sensitivity to asthma triggers

reduce symptoms and decreases risk of exacerbations

40
Q

What are the common SE of inhaled corticosteroids for asthma and patient eduction to reduce this?

A

Thrush
Hoarseness (dysphonia)
Localized contact hypersensitivity
Cough and throat irritation

Should wash out mouth after use

41
Q

What are the rare SE of inhaled corticosteroids for asthma? What do you need to monitor as a result?

A

Less common systemic
Impaired growth in children on long-term therapy
Osteoporosis in adults on long-term / high dose therapy
Cataracts
Glaucoma
Weight changes and adrenal suppression

Regular eye exams with h/o or family h/o glaucoma
Monitor growth in children on ICS (BMI <15%); cortisol levels
Watch calcium and Vit D intake in women and children on ICS
ICS is the recommended inhaler in pregnant women. Budesonide (Pulmicort) is proven very safe in pregnancy. Proventil is also safe.

42
Q

What is the preferred ICS for preggos?

A

Pulmicort
Proventil

Both Ps = preggo!

43
Q

What systemic corticosteroids do you use for asthma? When do you give these?

A

Prednisone
Prednisolone
Methylpredinsolone

5 days for kiddos
7 days for adults

Oral always, because it works just as quickly

Always give to moderate/severe asthmatics

44
Q

What are the SE of prednisone, prednisolone, and methylprednisolone?

A

Side Effects
Contraindications
Skin and soft tissue
Cushingoid appearance / weight gain
Cataracts / glaucoma
CV disease
GI disease - gastritis, ulcer formation, GI bleeding, pancreatitis
Hyperinsulinemia with insulin resistance

45
Q

What are the LABAs and when do you use it?

A

Only after starting SABA + systemic steroid

salmeterol
formoterol
arformoterol

46
Q

What is the MOA of LABAs and therefore associated SE?

A

Affects smooth muscle not limited to the airways and therefore can affect smooth muscle in the heart causing tachycardia and palpitations
Shakiness
Cramping of hands, legs and feet
May cause worsening of symptoms if used too often

47
Q

How are ICS and LABAs typically taken? Pros/cons?

A

As a combo drug when not controlled with high dose ICS

Beneficial because you have the bronchodilator working to widen the airway + inhaled corticosteroid that reduces and prevents inflammation of the airway

Limitations - COST - 2nd tier on most insurance plans

48
Q

What are the anticholinergics for asthma?

A

Ipratropium bromide
Tiotropium bromide
Ipratropium and albertol

Relax airways and reduces mucus in airways

49
Q

What is theophylline?

A

Nonselective phosphodiesterase enzyme inhibitor
Mild bronchodilation, anti inflammatory, enhances mucociliary clearance, and strengthens diaphragmatic contractility
Add on medicine for moderate to severe asthma
Monitor serum concentrations
Not for acute exacerbations

Not used often!

50
Q

What is the benefit of leukotrienes? Suffix?

A

Reduce mucous like crazy

Suffix = lukast

Prof Davis would be a drug rep for Montelukstat (singulair)

51
Q

What is the MOA of -lukast?

A

Blocks the actions of cysteinyl leukotrienes at the CysLT1 receptor on target cells such as bronchial smooth muscle via receptor antagonism
Improves asthma symptoms and reduces exacerbations and limit markers of inflammations such as eosinophil counts in the peripheral blood and bronchoalveolar lavage fluid proving they have antiinflammatory properties

52
Q

What is the BB warning for -lukast?

A

Psych at night, behavior issues

53
Q

What is cromolyn?

A

Mast-cell stabalizer
For early/late asthma
Only as nebulizer

54
Q

What is Nebulized Epi?

A

Racemic
Alpha and beta agonist
Bronchiole dilation, decreased mucous membrane secretion, reduce edema

55
Q

What are the SE of Nebulized epi?

A

Restlessness, anxiety, tachycardia, etc.
Children should be monitored closely in the ER or hospital setting for at least 3 - 4 hours after a single dose due to “rebound phenomenon”

56
Q

What Monoclonal antibodies used for asthma?

A

Omalizumab

DNA-derived, igG antibody binds to igE

Allergy related
BBW of anaphylaxis (need epi in case)

57
Q

How are patients now treated when dx first with asthma?

A

ICS and a SABA!

ICS typically used only during exacerbation, but can be used daily

58
Q

What are the six steps of asthma treatment?

A
  1. SABA + low dose ICS when symptomatic or low dose ICS daily
  2. SABA + low dose ICS
  3. SABA + low dose ICS + LABA OR medium dose ICS alone
  4. SABA + medium dose ICS + LABA
  5. SABA + high dose ICS + LABA (or montelukast)
  6. SABA + high dose ICS + oral steroids + LABA (or montelukast); consider monoclonal antibody
59
Q

How do you use a inhaler with spacer?

A

Breathe in and hold breath

60
Q

How do you desensitize asthmatics?

A

Allergy shots to expose them

61
Q

How often do you monitor patients with asthma?

A

Routine follow-up visits for patient with active asthma are recommended every 1-6 months depending upon the severity of asthma. Recommended 2-6 week follow up after any new med is administered to reassess function

62
Q

When should you step down treatment for asthma treatment?

A

If stable for 3+ months

Wanna do lower potency for example

63
Q

What do you base an asthma diary off of?

A

Peak flow meter

How often they are in the red, yellow, and green

64
Q

How do you determine asthma control?

A

Well controlled
Symptoms ≤ 2 days of symptoms a week

Not well controlled
Symptoms > 2 days a week or multiple times a night

Very poorly controlled
Symptoms persist throughout the day
A 20% change in value from AM to afternoon or day to day shows poor control

Can also give an asthma test

65
Q

What are the goals of asthma treatment?

A

Relief from symptoms
Minimal need of SABAs to relieve symptoms
Few night-time awakenings
Optimal lung function
Normal ADLs - work, school, athletics, etc.
Satisfaction of care among patients and families
Prevent recurrent exacerbations, including ED and hospital care
Optimal treatment plan (pharmacotherapy) with minimal SEs

66
Q

What is the patient education for asthma?

A

Patient needs to understand and become an active partner in managing their asthma
Patients must learn how to monitor their symptoms and pulmonary function
Possible triggers
How to take their medicine properly
Instruction on how to use peak flow meters and a detailed treatment plan should be given to all patients especially when first starting a treatment plan or if changes are made “Asthma Action Plan”

67
Q

When do you refer to pulm or allergist?

A

Unclear asthma dx
spirometry
life threatening asthma attack
The patient has been hospitalized or on more than 2 rounds of oral corticosteroids
The patient over 5 yrs old requires step 4 care or higher; a patient under 5 yrs old requires step 3 or higher
Unresponsive to treatment or uncontrolled therapy after 3 - 6 months of active therapy and monitoring
Diagnosis is uncertain
Other conditions complicate management
Additional diagnostic tests needed
Patient may be a candidate for allergen immunotherapy

68
Q

What is exercise-induced asthma?

A

Coughing, SOB, wheezing, chest tightness stars in 3 min, peaks 10-15 min, resolves within 60 minutes without broncho

69
Q

What is the PFT for exercise-induced asthma? What do you write for them? How do you diagnose?

A

Normal
A trial of an inhaler reduces symptoms = diagnosed with exercise-induced asthma

70
Q

What is cough-variant asthma?

A

Non-productive cough
PFT normal
Bronchodilator = recovers symptoms = diagnosed

71
Q

What is an Acute Asthma Attack (AAA)?

A

All asthma attacks give a warning
Warning signs and symptoms for adults may include:
Increased SOB or wheezing
Disturbed sleep caused by SOB, coughing or wheezing
Chest tightness or pain
Increased need to use bronchodilators (SABAs)
A fall in peak flow rates as measured by a peak flow meter
Warning signs or symptoms for children may include:
An audible whistling or wheezing when the child exhales
Coughing, especially when the cough is frequent and occurs in spasms
Waking at night with coughing or wheezing
SOB, which may or may not occur when the child is exercising
A tight feeling in the child’s chest
Primary care vs hospital treatment

72
Q

How do you treat AAA?

A

Albuterol inhaler
Monitor O2
<94% on child <92% for adult then O2 supplementation
-albuterol/aprovent solution
-recheck
-then third nebulizer treatment

If 3 nebulizers, it is an emergency, then they will go to PICU

Also give oral steroid

73
Q

What is the most severe variant of asthma?

A

Status asthmaticus

74
Q

What is the presentation of Status asthmaticus?

A

The most severe form of asthma
The lungs are no longer able to provide the body with adequate oxygen or remove carbon dioxide
Many organs begin to malfunction
Build-up of carbon dioxide leads to acidosis
Blood pressure may fall to low levels
The airways are so narrowed that it is difficult to move air in and out of lungs (from so much mucous)
Require intubation and ventilator support as well as maximum doses of several medications
Support is also given to correct acidosis

Clin Med IIB Pulmonology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions