ASTHMA

Question 1

laboratory tests for asthma diagnosis?

Answer 1

1. spirometry: fev1/fvc less than 80%
2. 12% fev1 increase with brochodialtor
3. cbc count esnophil increase indicate allergic component. and iges
4. ABGs: severe distress, suspected hypoventilation, or PEFR or FEV1 30% or less after initial treatment.
   5: pft performed for 5 yrs or older
   6: oximetry to check hypoxemia

Spirometry may be normal if the patient is not symptomatic.

Question 2

Complications of asthma

Answer 2

* Status asthmaticus*
Severe, life-threatening attack refractory to usual treatment where patient poses risk for respiratory failure

Question 3

asthma categories

Answer 3

Acute Asthma
Chronic Asthma
* Intermittent Asthma
* Persistent Asthma
Mild
Moderate
Severe

Question 4

Desired Outcomes in Chronic Asthma

Answer 4

• Maintaining Long-term Control
• using the Least Amount Of Medications
• Minimizing ADR.

Question 5

Desired Outcomes in Acute Asthma
treatment goals

Answer 5

• Correct significant hypoxemia
• Reverse airflow obstruction rapidly
• Reduce the likelihood of exacerbation relapse or recurrence of severe airflow obstruction in the future

Question 6

non pharmacological treatments of asthma

Answer 6

1. patient education
2. avoid triggers
3. vacinnation
4. avoid medications

Question 7

Patient education in asthma

Answer 7

• Asthma trigger avoidance
• Proper administration of inhaled medications
• Asthma self-management

Question 8

vaccination needed for asthmatic patient

Answer 8

• influenza yearly needed for patient of 6mnths or older
• Pneumococcal Polysaccharide Vaccine needed dose before age 65 and one after 65

Question 9

drugs that cause asthma

Answer 9

1. non selective Beta Blockers
2. Aspirin & NSAIDs

For patients with asthma requiring β-blocker therapy, a β1-selective agent is the best option.

asprin sensitivity adults present with rhinitis and nasal polyp with asthma

Question 10

What is the best route of administration of asthma medications & why?

Answer 10

Faster onset of action
Lower effective dose
Lower incidence of systemic S.E.

Question 11

Inhalational Drug Delivery Devices

Answer 11

Metered – Dose Inhaler (MDI)
Dry powder inhaler
Soft mist inhaler
Nebulizer: Jet & Ultrasonic

Question 12

use of spacer and valve holding chamber with MDI?

Answer 12

• Decrease the need for coordination of actuation with inhalation
• Decrease oropharyngeal deposition
• Increase pulmonary drug delivery.

Question 13

MDI advantages and disadvantage?

Answer 13

advantages:
* medication delivery in 2 mins
* portable, durable
* low med dose needed
disadvantage
* techinque / coordinatioon difficult
* Propellant may taste bad or irritate the airways

Question 14

Proper MDI Technique?

Answer 14

Shake the inhaler well
Remove the cap.
2. Exhale all air away from the inhaler.
3. Place the mouthpiece into the mouth with lips closed tightly around the inhaler.
4. To deliver a dose, press down on the canister ONE TIME while inhaling a slow steady breath. A puff of medication is sprayed out of the inhaler into the mouth.
5. Hold your breath for 10 seconds.
6. Exhale from nose.
7. Wait 1-2 minute if the dose is to be repeated.
8. Recap the inhaler when you are finished.
9. Rinse your mouth with water esp. if the medication is inhaled corticosteroid.

Question 15

what If a counter is not available on the inhaler?
For patients who can not hold their breath for 10 seconds?

Answer 15

the patient should count the number of puffs used, to determine when the inhaler is empty.

instruct them to hold their breath as long as possible.

Question 16

adv and disadvantages of dry power inhalation

Answer 16

adv:
1. sweet taste have lactose which is less to caue lactose intolarance
2. easy to use
3. quick delivery of medicine

disadavn:
1. require cordnition
2. not used for children less thn 4 due to high inspirtaory colume
3. less stable after opeing

Question 17

adv and disadv
of soft mist inhaler

Answer 17

adv
1. no dry power or propellet
2. better lung deposition

disadv
* require coodination
* challenge to assemble first time use

Question 18

Adult-onset asthma related to

Answer 18

atopy, nasal polyps, aspirin sensitivity, occupational exposure, or recurrence of childhood asthma.

Question 19

Ics poor adherence and no response to treatment due to?

Answer 19

The main reasons for poor adherence are: the slow onset of action and concerns about systemic SE.
• Considerable variability in response to ICS exists, with up to 40 % of patients not responding to ICS.
• This lack of response may be related to functional glucocorticoid-induced transcript 1 gene variant in some patients with asthma

Question 20

Side effects of inhaled corticosteroids

Answer 20

oral candidiasis, cough, and dysphonia.Hoarseness

Decreasing the dose reduces the incidence of hoarseness. Low and medium dose ICS were reported to affect children growth velocity.

Question 21

Systemic corticosteroids
When
Drugs
Dose
Route

Answer 21

Prednisolone & methylprednisolone
• acute asthma not responding to SABA
• Their onset of action is 4 - 12 hours, so they need to be started early in the course of acute attack.

The duration of therapy usually ranges from 3 - 10 days. Treatment with systemic corticosteroids should be continued until PEFR is ≥ 70% of the personal best measurement and asthma symptoms are resolved.

Question 22

Early-Phase Response

Answer 22

Peaks 30-60 minutes post exposure, subsides 30-90 minutes later

Characterized primarily by bronchospasm

Increased thick sputum secretion with edema formation

Patient experiences wheezing, cough, chest tightness, and dyspnea

Question 23

2. Late-Phase Response

Answer 23

Characterized primarily by inflammation

Histamine and other mediators set up a self-sustaining cycle increasing airways reactivity causing hyper-responsiveness to allergens and other stimuli

Increased airway resistance leads to air trapping in alveoli and hyperinflation of the lungs

If airway inflammation is not treated or does not resolve, may lead to irreversible lung damage

Question 24

Clinical Presentation & Diagnosis of asthma

Answer 24

Symptoms:
1. Wheezing
2. Shortness of breath (SoB)
3. Coughing (typically worse at night)
4. Chest tightness

Additional Symptoms:
* Anxiety and agitation
* In acute severe asthma, patients may have difficulty communicating in complete sentences
* Mental status changes (e.g., confusion, irritability, agitation)
* Bradycardia and Absence of wheezing may indicate impending respiratory failure
* Symptoms exacerbated by precipitating factors such as smoke or viral illness
* Symptoms often follow a pattern (e.g., worse at night, seasonal variations)

Question 25

hospitilize patient for acute asthma

Answer 25

If patient needed hospitalization: oxygen, continuous nebulization of SABA, systemic corticosteroids (OCS) are used.
Patients with oxygen saturation less than 90% in children, pregnant women, and patients with coexisting heart disease, receive oxygen with the dose adjusted to keep oxygen saturation above 90%.
Administration of low oxygen concentrations (< 30%) by nasal cannula or facemask is usually sufficient to reverse hypoxemia in most patients.

Question 26

Asthma Self-Management

Answer 26

freedom to adjust therapy based on personal assessment of disease control using a predetermined plan.
Tools to assess asthma control are: evaluating symptoms of worsening asthma & monitoring PEFR.
Providing patients with a prescription for oral corticosteroids to use PRN for asthma exacerbation is part of asthma self-management.

Question 27

Instructions given to the patient to prevent exercise-induced asthma:

Answer 27

Warming up prior to exercise
Covering mouth & nose with a scarf or mask during cold weather.
Pretreatment with SABA or low dose ICS+formoterol 5 - 20 minutes prior to exercise: the treatment of choice and will protect against bronchospasm for 2 - 3 hours.