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Clin Med B 2 > Asthma > Flashcards

Asthma Flashcards

1
Q

what are the multiple contributing factors to the pathogenesis of asthma

A
  • Inflammatory cell infiltration with eosinophils, neutrophils, and lymphocytes
  • goblet cell hyperplasia
  • plugging of small airways with thick mucus
  • hypertrophy of smooth muscle
  • airway edema
  • mast cell activation
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2
Q

what is the strongest identifiable risk factor for the development of asthma

A

atopy - the genetic tendency to develop allergic diseases

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3
Q

what are other risk factors for asthma

A

obesity
aspirin and NSAIDS
GERD
Beta blockers
family hx

theres more but these are the ones im learning

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4
Q

what ages are asthma most likely to begin?

A

by 1 year - 26%
1-5 years - 51%
>5 years - 22%

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5
Q

what are the 7 types of asthma

A
  • extrinsic (allergic)
  • intrinsic (uncommon)
  • mixed (ex and intrinsic combo)
  • occupational
  • drug induced (ASA/NSAID)
  • exercise induced
  • cough variant
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6
Q

what is the diagnostic approach to a suspected asthma patient

A

diagnosis is clinical
confirmed with PFTs (spirometry)

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7
Q

what are s/s of asthma

A

cough
chest tightness
SOB/Dyspnea
Difficulty breathing
episodic wheezing

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8
Q

what would the PE show in asthma

A
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9
Q

What would a lung exam show in asthma

A
  • hyperinflation
  • retractions
  • decreased tactile fremitus
  • rhonchi and wheeze
  • prolonged expiration
  • silent chest = severe asthma
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10
Q

what physical examination finding indicates a life threatening status

A

silent chest auscultations

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11
Q

what is the diagnostic criteria for asthma in children

A
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12
Q

what is the diagnostic criteria for asthma in adults

A
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13
Q

what is other testing that can be done in diagnostic testing for astham

A
  • bronchoprovocation testing
  • exercise challenge
  • peak flow meters
  • CXR
  • skin testing
  • measurement for sputum for eosinophils
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14
Q

what are the indications for a CXR in asthma

A

if diagnosis of asthma is uncertain

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15
Q

in acute asthma exacerbations, how often are abnormal findings present in CXR

A
  • Abnormal findings at presentation - 5%
  • Abnormal findings if no improvement in 12 hours - 34%
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16
Q

what does ABG show in acute exacerbation of asthma

A
  • Hypoxemia
  • hypercarbia with decompensation
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17
Q

what does a CBC show in acute exacerbation of asthma

A
  • Eosinophillia may be present
  • increased levels of IgE may be present
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17
Q

what does a Sputum sample show in acute asthma exacerbaiton

A
  • casts of small airways
  • thick mucoid sputum
  • Curschmanns spirals
  • Charcot-Leyden crystals
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17
Q

what are possible complications of asthma

A
  • Exhaustion
  • Dehydration
  • Airway infection
  • Tussive syncope
  • Pneumothorax
  • Respiratory Failure
  • Chronic lung disease
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17
Q

what is considered severe persitent asthma

A
  • symptoms of asthma throughout the day each day
  • night-time awakenings nightly
  • need for SABA multiple times/day
  • extreme limitation in normal activity
  • FEV1<60% predicted and FEV1/FVC below normal
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17
Q

what is the MC bronchoprovocation test in the US

A

the Methacholine Challenge - patients breathe in increasing amounts of methacholine and perform spirometry after each dose.

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17
Q

what is a positive methacholine challenge

A

Increased airway hyperresponsiveness with a ≥ 20% decrease in FEV1 up to 16 mg/mL max dose

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17
Q

what is considered mild persistent asthma

A
  • symptoms occur more than 2 days/week but not daily
  • aprox 3-4 night-time awakenings/month d/t asthma but not weekly
  • use of SABA more than 2x week but not daily
  • minor interference w normal activities
  • FEV1 measurements w/i normal range and normal FEV1/FVC
  • 2+ exacerbations/year requiring oral steroids
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17
Q

what is considered mild intermittent asthma

A
  • daytime symptoms 2 or fewer days/week
  • 2 or less night awakenings per month
  • use of SABA inhaler 2 or fewer times/week
  • no interference w normal activities between exacerbations
  • FEV1 measurements between exacerbations are >80%
  • FEV1/FVC ratio normal between exacerbations
  • 0-1 exacerbations requiring oral steroids/year
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17
Q

what is considered moderate persistent asthma

A
  • daily symptoms of asthma
  • nighttime awakenings more than once per week
  • daily need for SABA
  • some limitation of normal activity
  • FEV1 between 60-80% of predicted and FEV1/FVC below normal
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17
Q

which medications are referred to as “rescue inhalers”

A

albuterol
levabuterol
(SABAs)

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17
Q

what do SABAs do in asthmatic patients

A

work to relax the smooth muscle of the airway and cause prompt increase in airflow and decrease in symptoms

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18
Q

what are the SE of SABA?

A

tachycardia
shakiness
nervousness

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19
Q

what are the preferred long term controllers

A

inhaled corticosteroids

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20
Q

what are the common inhaled corticosteroids

A

pulmicort (budesonide)
Qvar (Beclometasone)
Asmanex(Mometasone furoate)
flowvent (fluticasone propionate)

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21
Q

what do inhaled corticosteroids do in asthmatic patients

A

reduce airway inflammation and reduces the airways exaggerated sensitivity to any and all triggers of asthma

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22
Q

What are the MC SE of inhaled corticosteroids

A

thrush
hoarsness
localized contact hypersensitivity
cough and throat irritation

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23
Q

what are the less common SE of inhaled corticosteroids

A

impaired growth in children
osteoporois in adults
cataracts
glaucoma
weight changes and adrenal suppression (cushings)

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24
Q

how can patients reduce the possibility of developing thrush when using inhaled corticosteroids

A

rinse your mouth out after using!

25
Q

When do you use systemic corticosteroids

A

in acute asthma attacks

26
Q

what are the oral systemic corticosteroids

A

prednisone
prednisolone
solumedrol (methylprednisolone)

27
Q

What are SE of systemic corticosteroids

A
  • skin and soft tissue Infections?
  • cushings/weight gain
  • cataracts/glaucoma
  • CV disease
  • GI disease
  • hyperinsulinemia w insulin resistence
28
Q

when are the LABA medications used in treatment for asthmatic patients

A

in combination with other medications - usually ICS - rarely a monotherapy

29
Q

what are the LABAs used in asthmatic patients

A

salmeterol
formeterol
aformeterol

30
Q

what are the SE of LABAs

A

tachycardia
palpitations
shakiness
cramping
worsening of symptoms (if used too often)

31
Q

what are the ICS plus LABA combo medications used in asthmatic patients

A

budesonide + formoterol
fluticasone + salmeterol
Fluticasone + Vilanterol
Mometasone + formoterol

32
Q

Why are ICS plus LABA combos beneficial

A

the bronchodilator works to widen the airway + inhaled corticosteroid reduces and prevents inflammation of the airway

33
Q

What are limitations of ICS plus LABA therapy in asthmatic patients

A

COST
most insurance plans have them as 2nd tier

34
Q

when do you use LABA + SAMA in asthmatic treatment

A

not first line, but can be used if unresponsive to therapy in combination with SABA

35
Q

what are the LABA + SAMA therapies

A

ipratropium bromide
tiotropium bromide
ipratropium and albuterol

36
Q

How do LABA + SAMA aid in the treatment of asthma

A
  • relax the airways and prevent them from getting narrower
  • also reduce the amount of mucous in the airway.
37
Q

what is theophylline used for in the treatment of asthmatic patients

A

add on medication for moderate to severe asthma

38
Q

what is the drug class of theophylline

A

nonselective phosphodiesterase enzyme inhibitor

39
Q

what does theophylline do to treat asthma

A
  • mild bronchodilation
  • anti inflammatory
  • enhances mucociliary clearance
  • strengthens diaphragmatic contractility
40
Q

what should theophylline NOT be used for

A

acute exacerbations of asthma

41
Q

what is the MOA of leukotrienes

A

blocks actions of leukotrienes at the CysLT1 receptor on target cells such as bronchial smooth muscle via receptor antagonsism

42
Q

what effect do leukotrienes have on asthma

A
  • improves symptoms/reduces exacerbations
  • limits inflammatory markers like eosinophils
43
Q

what is the black box warning for leukotrienes (specifically montelukast)

A

serious mental health side effects.

44
Q

What are the leukotrienes

A

montelukast
zafrilukast

45
Q

When is Cromolyn used in asthmatic treatment

A

not used first line
may be an option if someone fails or cant tolerate ICS

46
Q

What is the MOA of Cromolyn

A

Mast cell stabilizer -
prevents asthmatic responses and reduces airway reactivity to a range of inhaled irritants.

47
Q

What are the down falls of Cromolyn

A

not available in inhaler form and is only available in nebulizer solution.

48
Q

When is nebulized epinephrine used as a asthma treatment

A

in patients with severe asthma attacks. Results in rapid improvement of upper airway obstruction.

49
Q

What is the MOA of nebulized epinephrine

A

a sympathomimetic alpha and beta agonist. this results in bronchodilation, decreased edema, and decreased mucous.

50
Q

what are the SE of nebulized epinephrine

A

restlessness
anxiety
tachycardia
usually lasts no more than 2 hours.

51
Q

what should be monitored when giving children nebulized epinephrine

A

when taking nebulized epinephrine, children can suffer from the “rebound” effect and therefore should be monitored in an ER or hospital setting for at least 3-4 hours after a single dose.

52
Q

What is the monoclonal antibody medications used in asthma that we learned

A

Omalizumab

53
Q

what is the MOA of monoclonal antibodies in asthma treatment

A

this is DNA-derived IgG antibodies which bind to IgE mast cells and reduce mediator release which therefore decreases allergic response.

54
Q

who can receive monoclonal antibodies

A

children 6 years and older (injection only)

55
Q

what type of patient is indicated for treatment with monoclonal antibodies

A
  • Moderate-severe uncontrolled asthma in person w/ positive skin prick testing to perennial allergies who is inadequately controlled on max dose of other meds
  • also in those with chronic urticaria
56
Q

what is the black box warning for monoclonal antibodies

A

anaphylaxis! so monitor closesly!!!

57
Q

what are the 6 steps of asthma treatment

A
58
Q

How often should you follow up with a patient with asthma

A
  • every 1-6 months depending upon the severity of the asthma
  • every 2-6 weeks after any new med admin
59
Q

when should stepping down from treatment be considered in patients with asthma

A

if their asthma is stable for 3 months or more

60
Q

what are the peak flow values that indicate asthma severity

A
61
Q

what is considered well controlled asthma

A

less than 2 days a week with symptoms

62
Q

what is considered not well controlled asthma

A

more than 2 days a week of symptoms or multiple symptoms during the nighttime

63
Q

what is considered very poorly controlled asthma

A
  • symptoms persist throughout the day.
  • a 20% change in peak flow from AM to afternoon or day to day shows poor control
64
Q

When should you refer/consult a pulmonologist or allergist

A
  • life threatening asthma attacks
  • hospitalized or 2+ rounds of oral steroids
  • over 5 with step 4 care or more, or younger than 5 and step 3 care or more
  • unresponsive/uncontrolled after 3-6 mo of active therapy
  • diagnosis uncertain
  • additional diagnostic tests needed
  • if pt is candidate for allergen immunotherapy
65
Q

What is exercise induced asthma

A

a condition in which the airways narrow significantly during vigorous exercise

66
Q

what are symptoms of exercise induced asthma

A

cough
wheezing
SOB
chest tightness

67
Q

what is the timeline for exercise induced asthma

A

starts at onset or 3 min after
peaks at 10-15 minutes
resolves within 60 minutes

68
Q

what medications are typically used to treat exercise induced asthma

A

usually bronchodilators - SABA
* albuterol
* pirbuterol
* ipratropium and albuterol combo

take 15 min prior to exercise!

69
Q

what is cough variant asthma

A

chronic cough
>3 weeks
non productive
usually nocturnal

70
Q

what are warning signs of an impending asthma attack

A
  • Increased SOB or wheezing
  • Disturbed sleep caused by SOB, coughing or wheezing
  • Chest tightness or pain
  • increased need to use bronchodilators
  • afall in peak flow rates as measured by a peak flow meter
71
Q

what are warning signs for symptoms for children prior to an asthma attack

A
  • audible wheeze/whistle with exhale
  • coughing in spasms
  • waking at night with coughing/wheezing
  • SOB w or w/o exercise
  • tight feeling in chest
72
Q

what is status asthmaticus

A

the most severe form of asthma during which lungs can no longer provide oxygen and remove CO2

leads to multi organ damage, acidosis, hypotension, and narrowed airways.

73
Q

what is the treatment for status asthmaticus

A

requires intubation and ventilator support as well as maximum doses of several medications

also meds for acidosis correction.

Clin Med B 2 (44 decks)

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