Asthma Flashcards
Safest asthma medication to use in pregnancy
Inhaled corticosteroids (Advair, Dulera, Symbicort)
True or false. Strenuous exercise should be avoided in asthmatics
False
Take inhaler/LTRA 5-20 minutes before exercise
Which ethnicities most commonly suffer from asthma?
Puerto Rican > Black > White > Mexican
What does FEF 25-75 measure?
Average forced expiratory rate during mid FVC
Apart from spirometry, another kind of pulmonary function test which gives more detail but is rarely done is …
Plethysmography
Which asthma medications are associated with cleft palate and gastroschisis birth defects if taken during pregnancy?
SABA (Albuterol, levalbuterol)
Does the hyper-responsive inflammatory component of asthma relate to the mucosal or smooth muscle layer of the airway?
Mucosal
Constriction is the smooth muscle layer
How many children with asthma have full remission during puberty
1 in 4
True or false. Asthma can often begin after the age of 50.
False. If onset is after age 50, it’s probably not asthma
A patient with asthma day symptoms 6 times a week and night symptoms once a week, with an FEV1 of 82% would get what treatment?
Low-dose ICS (Advair, Dulera, Symbicort)
(patient is in mild persistent class)
True or false. Allergy testing can diagnose asthma.
False.
May identify triggers, but cannot diagnose
Describe (4) potential causes of nocturnal asthma
Physiologic sleep changes
Bedroom/late-day allergens
GERD
Sleep apnea
(take asthma meds before bed, might help)
Which asthma medication is associated with cleft palate, pre-eclampsia, gestational diabetes, and low birth weight complications if taken during pregnancy?
Oral steroids
Asthma is commonly seen in a “march” with these two other conditions
Atopic dermatitis (eczema)
Seasonal allergies
What should be given to a patient with occupational asthma?
Take home peak expiratory flow device for them to measure at work
In addition to spirometry, what needs to be added to diagnose asthma?
Bronchodilator and repeat spirometry
Improvement = asthma
How long should systemic steroids be used in outpatient management of asthma?
One to three weeks
Avoid long term use
What is the gold standard for asthma diagnosis?
Methacholine/histamine challenge
Which type of PFT is most commonly done in asthma testing?
Spirometry
Theophylline is rarely used in asthma management due to …
Risk of seizures/arrythmias
For patients who don’t respond to initial asthma management in the ER, what are the next two potential steps?
2g IV magnesium
If that fails, then mechanical ventilation (with ABGs)
Describe initial asthma management in the ER
Supplemental O2
- >92% normally (>95% if pregnant)
Promptly give SABA
- add ipratropium if severe to relax lung muscles
Promptly give systemic glucocorticoids
Patients with asthma triggered by aspirin may have this unique sign on physical exam
Nasal polyposis
Asthma patients with atopic dermatitis (eczema) will have red, dry, inflamed skin on these areas of their body
Flexor surfaces of elbows and knees
The two most common asthma symptoms are …
Expiratory wheeze
Cough (worse at night)
A patient with asthma day symptoms once a week and night symptoms once a month, with an FEV1 of 90% would get what treatment?
PRN SABA (Albuterol)
(patient is in intermittent class)
In asthma would you see decreased FVC or decreased FEV1/FVC ratio on spirometry?
Decreased FEV1/FVC ratio (obstructive)
Nasal polyposis is associated with which sub-type of asthma?
Aspirin exacerbated asthma
Name some common environmental asthma triggers
Ragweed
Dust
Mold
Exercise in cold air
Medications to avoid in asthma management
Non-selective beta-blockers (propranolol)
Aspirin too if they’re one of those ones
All suspected cases of asthma should be given this diagnostic test
PFT - pulmonary function tests
A patient with asthma day symptoms throughout the day and night symptoms often nightly, with an FEV1 of 50% would get what treatment?
Med-high ICS (Advair, Dulera, Symbicort) AND LABA (Salmeterol or Formoterol)
With or without oral prednisone
Upon ER discharge after an asthma attack, which medication should be prescribed, and for how long?
Oral corticosteroids (prednisone)
For 5-7 days
Best management medication for asthma in patients with co-occurring allergies/atopy
Humanized monoclonal antibodies against IgE
Xolair
In treatment of post-nasal drip in asthmatics, what unique physical exam sign would be seen?
Cobble stoning of the throat
Describe the appearance of a flow-loop pattern in asthma
Scooped out shape and smaller (obstructive)
In restrictive lung diseases would you see decreased FVC or decreased FEV1/FVC ratio on spirometry?
Decreased FVC
True or false. Leukotriene inhibitors are less effective than inhaled corticosteroids for treatment of inflammation
True
A patient with asthma day symptoms 7 times a week and night symptoms five times a week, with an FEV1 of 72% would get what treatment?
Low-dose ICS (Advair, Dulera, Symbicort) AND a LABA (Salmeterol or Formoterol)
OR
Medium dose ICS
(patient is in moderate persistent class)
These four signs on physical exam indicate a more severe case of asthma
Hyper-resonance of chest
Use of accessory muscles in breathing
Pulsus paradoxus
Quiet chest (low air flow)
Describe the appearance of a flow-loop pattern in restrictive lung diseases
Normal shape, decreased size
1 in 10 school age children, but is it more common in boys or girls in childhood and men or women as adults?
Boys in childhood and women in adulthood
Name medications that commonly trigger asthma
Aspirin
Non-selective beta-blockers
Asthma in pregnancy usually shows up in which trimester?
2nd trimester
