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Pulmonology Exam 2 > Asthma > Flashcards

Asthma Flashcards

1
Q

Asthma Definition

A

Episodic airway obstruction and hyperresponsiveness usually accompanied by airway inflammation
1. Episodic
2. Obstruction (reversible)
3. Hyperresponsiveness
4. Inflammation

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2
Q

Asthma has a high incidence in what population?

A

Puerto rican

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3
Q

Natural History of asthma in adults

A

o Females > Males
o Perimenopause
o If start wheezing in adolescence or adulthood- likely to persist but
likely to not progress markedly in severity

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4
Q

Atopy:

A

genetic predisposition to develop
specific immunoglobulin E (IgE) antibodies directed against common environmental allergens

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5
Q

Atopic triad

A

Asthma
Eczema
Allergies

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6
Q

Serum levels of ____ correlate closely with
the development of asthma

A

IgE

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7
Q

Environmental risk factors of asthma

A
  1. Allergen exposure in those with a predisposition to atopy
    o 50% have atopy (high IgE) allergic sensitization
    o Most common allergens: house dust mites, indoor fungi, cockroaches, and
    indoor animals
  2. Occupational exposure
  3. Air pollution
  4. Infections (viral and Mycoplasma) RSV, rhinovirus
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8
Q

Lifestyle Risk Factors for asthma

A
  1. Tobacco- maternal smoking, secondhand, and active (4x risk)
  2. Obesity - dose-dependent effect of body mass index (BMI) on
    asthma risk
  3. Diet
    o Vitamin D Def- also maternal Vit D def (Studies not
    statistically sig but show evidence)
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9
Q

Elements of Asthma (pathophysiology)

A

o Bronchoconstriction
o Airway edema and inflammation
o Airway hyperreactivity
o Airway remodeling

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10
Q

Presentation of Asthma

A

o Episodic wheezing
o Shortness of breath
o Chest tightness
o Cough
o Sxs vary in intensity and over time
o Often worse at night
o Triggers

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11
Q

Triggers of asthma can include:

A

Environmental/occupational allergens
Cold, dry air
Emotion
Infections
Inhaled irritants
Exercise
Aspirin, NSAIDS
GERD
Allergic rhinitis

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12
Q

Work-up for asthma

A

o History & Exam
o Pulmonary function tests- spirometry
o confirm and quantify the severity and reversibility of airway
obstruction
o methacholine challenge testing option if PFTs normal but suspect
stil
o X-ray to exclude other causes dyspnea
o Allergy testing in kids may help reduce allergic component

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13
Q

FEV1 vs FVC

A

o FEV1: the forced expiratory
volume in one second
o FVC: the total amount of air
that can be expelled from
full lungs

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14
Q

What can pulmonary function tests tell you about asthma?

A
  • Pre-bronchodilator:
  • ↓ FEV1, ↓FEV1/FVC <0.8
  • FVC may be low
  • Post-bronchodilator
  • FEV1 or FVC ↑ > 10-12%, sxs reversible
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15
Q

How often should spirometry be done for asthma?

A

Spirometry at diagnosis, 3-6 mos, and periodically as needed

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16
Q

Treatment goals for asthma

A
  • Goal #1: minimize
    chronic sxs that
    interfere with life
  • Goal #2: reduce
    exacerbations
17
Q

Criteria of good asthma control:

A
  • Symptoms of asthma requiring quick-reliever medication no more than two days per week
  • Night-time awakenings no more than two nights per month
  • Lung function (PEF or FEV1) within the normal range (or within 20 percent of the patient’s personal best value)
  • No more than one exacerbation in the past year requiring urgent care and/or oral glucocorticoids
18
Q

Clinical Course of asthma

A

o Often resolves in kids
o 1 in 4 kids persist with wheezing into adulthood or relapse
o Good prognosis with treatment adherence and periodic eval
o Some pts have permanent airway remodeling and obstruction

19
Q

Complications of Asthma

A

o Exhaustion
o Dehydration
o Airway infection
o Tussive syncope
o Pneumothorax occurs but is rare
o Acute hypercapnic and hypoxemic
respiratory failure occurs in severe
disease

20
Q

SABAs (short-acting beta agonist)

A
  • Albuterol
  • Levalbuterol
21
Q

LABAs

A
  • Salmeterol
  • Formoterol
22
Q

LAMAs

A
  • Tiotropium Spiriva
23
Q

LTRA (Leukotriene
receptor antagonist)

A
  • Monteleukast Singulair
24
Q

ICS

A
  • Fluticasone
  • Budesonide
  • Ciclesonide
25
Q

Stepping Down guidelines in Asthma

A
  • After stable for 3-6 mos, may step down
  • Reduce cost, side effects
26
Q

Patient Education for Asthma

A

o WHAT is asthma
o WHEN medications
o WHY medications
o HOW to take medications
o Avoidance of triggers- work exposure, allergens, dust
mites/pets, food, don’t avoid exercise (pre-treat)
o Action plan
o Self monitor via sxs or peak flow meter

27
Q

MDI (Metered dose) guidelines:

A

Shake inhaler, exhale, slow & deep
breath, hold for 5-10 sec

28
Q

DPI (dry powder) guidelines

A

Exhale, quick deep breath 3 sec, hold for 5
-10 sec

29
Q

Peak Flow Meter use

A

o Max exhalation after full
inspiration
o Correlates with FEV1
o Max effort- coach pt
o Perform 3 times; keep highest
o Compare to standardized chart
or patient personal best

30
Q

Exacerbation guidelines if 80%-100% of PEF from baseline:

A

use SABA as prescribed

31
Q

Exacerbation guidelines if 50% of PEF is severe

A

Go to ER

32
Q

Exacerbation guidelines if 50-80% of PEF

A

SABA 2-6 puffs Q 20 min x 1 hr, reassess

33
Q

Good, incomplete and poor response in asthma exacerbations

A

o Good response- No symptoms, Peak Flow reading of >80% personal best:
continue SABA every 3-4 hours PRN for 24-48 hours, frequently reassessing
with Peak Flow.
o Incomplete response- Persistent wheezing and Peak Flow reading of 50-80%
personal best: Continue SABA as above and add PO corticosteroid for 5-7
days.
o Poor response- Marked wheezing and Peak Flow reading of <50% personal
best: Repeat SABA immediately, go to ER (consider ambulance), and PO
corticosteroid should be initiated (at least)

34
Q

Asthma Attacks: Prevention

A

o Control triggers
o Stay on medicine

Pulmonology Exam 2 (5 decks)

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