Asthma Flashcards
Asthma vs COPD:
Which one is REVERSIBLE?
ASTHMA
What is Asthma?
A chronic lung disease characterized by inflammation of the bronchiole tubes and variable episodes of AIRFLOW OBSTRUCTION.
What 5 factors can cause an Asthma attack?
- Positive family history (genetics)
- High pollen counts, mold, pet dander
- Climate changes
- Air pollution
- Occupational factors (Chemicals, foods, compounds)
Is airflow obstruction in asthma usually reversible?
Yes, it is usually reversible with treatment or spontaneously.
What are the 3 HALLMARK signs of an asthma attack?
- Cough
- Dyspnea: hard getting air OUT- not in
- Wheezing: turbulent airflow in narrowed tubes
What are 5 LATE SIGNS of Asthma
- Chest tightness
- Diaphoresis: excessive sweating
- Tachycardia: HR >100
- Widened PULSE pressure: Syst - Dyast = __
- Hypoxemia: very severe stages
Q: What 2 things must we determine FIRST in order to DIAGNOSE asthma?
Determine an airflow obstruction is present and if it is at least partially reversible
- What “at least partially reversible” means: the obstruction in the airways can improve significantly after administering a bronchodilator, but it might not return to completely normal function. This characteristic helps differentiate asthma from other respiratory conditions.
4 common accompanying conditions in Asthma
- Viral infections
- GERD
- Eczema- KNOW
- rashes
Sputum & Blood Test for Asthma
List the 2 main ones
- Elevated Eosinophils (WBC)
- Elevated IgE: causes inflammation
Stages of ABG’s in Asthma:
Q: At FIRST, what do arterial blood gas (ABG) results typically show in asthma?
hypocapnia and respiratory alkalosis.
- hypocapnia: Low levels of PaCO2 (below 35 mmHg)
ABG’s in Asthma:
What shows LATER in ABGs during an asthma attack?
Increased PaCO2 (partial pressure of carbon dioxide) & respiratory acidosis
- CO2 is acid to the body
Q: What does a NORMAL PaCO2 level indicate during an asthma attack?
A: It may signal impending respiratory failure.
- It suggests that the patient may NOT be effectively ventilating and could be losing the ability to breathe adequately.
Which assessment finding would be MOST CONCERNING in a patient having an asthma attack?
a. Inspiratory wheezing
b. Productive cough
c. Tachycardia
d. Expiratory wheezing
a. Inspiratory wheezing
(high-pitched, musical sound that occurs during INHALATION)
- It suggests a more severe degree of airway obstruction and may indicate impending respiratory failure or significant respiratory distress.
ASTHMA:
What tests do you anticipate the HCP ordering?
List 5 tests
- Pulmonary function tests (spirometry)
- Methacholine challenge **
- Peak flow monitoring
- Chest x-ray: rules out other dx
- Allergy testing
What is the Methacholine challenge?
- test is performed to evaluate how “reactive” or “responsive” your lungs are- INDUCES asthma attack
- inhale doses of methacholine, a drug that can cause narrowing of the airways.
- A breathing test will be repeated after each dose of methacholine to measure the degree of narrowing or constriction of the airways
What does chest tightening indicate in asthma?
the bronchioles are constricting, making it harder for air to move through the lungs.
2 ways to prevent Asthma attack?
- Eliminate asthma triggers if possible
- Take meds as prescribed!
What are some serious complications of asthma?
List 3
- Status asthmaticus
- Respiratory failure
- Pneumonia
Define:
severe, prolonged asthma attack that does not respond to standard treatments like bronchodilators.
Status asthmaticus
Define:
During asthma attack, lungs can no longer provide adequate oxygen or remove enough carbon dioxide, resulting in life-threatening hypoxia or hypercapnia
Respiratory Failure
Define:
A lung infection that can develop due to increased mucus production during asthma attack and impaired airway clearance.
pneumonia
2 types of RELIEF medicatiins for asthma
(not cure it)
- Quick Relief Medications: Immediate RELIEF
- Long Acting Medications: MAINTAINS control of presistent asthma: used only if #1 doesnt work
KNOW RELIEF & MAINTAIN
Asthma/COPD:
List the 3 CLASSES of INHALED meds
- Beta Adrenergic Agonists
- Anticholinergics (muscarinic antagonists)
- ICS – Inhaled Corticosteroids
There are 2 TYPES of Beta Adrenergic Agonist
- SABA – Short Acting B2-Adrenergic Agonists
- LABA – Long Acting B2-Adrenergic Agonists
Both SABA’s and LABA’s end in
“ol”
Asthma Inhaled Meds:
Name the 2 Inhaled SABA meds (short acting)
- Albuterol (Ventolin, ProAir)
- Levalbuterol (Xopenex)
Asthma Inhaled Meds:
List the 3 Inhaled LABA meds (long acting)
- Salmeterol (Serevent)
- Formoterol (Foradil)
- Arformoterol (Brovana)
2nd Class of Inhalers for Asthma/COPD:
There are 2 TYPES of Anticholinergics (muscarinic antagonists)
- SAMA – Short Acting Muscarinic Antagonist
- LAMA – Long Acting Muscarinic Antagonist
- block the action of acetylcholine, which leads to bronchodilation.
SAMAs and LAMAs end in
“ium”
One medication that falls under SAMA
Ipratropium (Atrovent)
2 Meds that fall under LAMA
- Tiotropium (Spiriva)
- Umeclidinium (Incruse Ellipta)
3rd Class of Inhalers for Asthma/COPD:
2 MEDS that fall under ICS
(no types)
- Fluticasone (Flovent, Arnuity Ellipta)
- Budesonide (Pulmacort)
If Inhaled Meds DONT work we use SECOND meds in line
Name the 2 classes NEXT in line:
- Corticosteroids: non-inhaled
- Monoclonal Antibodies
Non-inhaled Corticosteroids end in
“one”
List the 3 Corticosteroid meds used for Asthma/COPD
- Hydrocortisone (Solu-Cortef)
- Methylprednisolone (Solu-Medrol)
- Prednisone (Medrol)
Hydrocortisone is administered via
IV
Methylprednisolone is administered via
- IV
- IM
Prednisone is administered via
Oral
Monoclonal Antibodies end in
“mab”
There are 2 TYPES of meds that fall under Monoclonal Antibodies
- Anti-IgE
- Anti-Interleukin 5
Which Monoclonal Antibodies med TYPE is used for MODERATE- SEVERE asthma
Anti- IgE
What is the ONE med that falls under Anti-IgE
Omalizumab (Xolair)
How is Omalizumab (Xolair) administered?
subQ
Which Monoclonal Antibodies med TYPE is used for SEVERE asthma
Anti-Interleukin 5
2 Meds that fall under the Anti-Interleukin 5 type
- Mepolizumab (Nucala)
- Reslizumab (Cinqair)
Mepolizumab (Nucala) is administered by
subQ
Reslizumab (Cinqair) is administered by
IV
3 Med Classes used in Asthma/COPD for ANTI-INFLAMMATION
- Leukotriene Modifiers
- PDE-4 Inhibitor (Targeting PDE-4 decreases inflammation)
- Methylxanthines
Leukotriene Modifiers have what abbreviations in their name?
“lu” or “leu”
2 TYPES of meds that fall under Leukotriene Modifiers
- Leukotriene Receptor (Blocker) Antagonists (LTRA)
- Leukotriene Inhibitor
Leukotriene Receptor (Blocker) Antagonists (LTRA) meds end in
-lukast
2 meds that fall under Leukotriene Receptor (Blocker) Antagonists (LTRA)
- Zafirlukast
- Montelukast
Zafirlukast and Montelukast are administered by
oral
ONE med falls under Leukotriene Inhibitor.
Zileuton (Zyflo)
Zileuton (Zyflo) is administered via
oral
While Leukotriene Modifiers are used for Asthma, PDE-4 inhibitors are mostly used for
COPD
PDE-4 Inhibitor has ONE med only.
Roflumilast (Daliresp)
(reduces inflammation)
When is Roflumilast (Daliresp) prescribed in COPD management?
ONLY for SEVERE COPD to reduce the frequency of exacerbations
What drug SHOULD NOT be used with PDE-4 inhibitors?
Theophylline - a methylxanthines med
Anti-inflammatory asthma/COPD:
The NEWER, MORE EFFECTIVE drugs right now.
Methylxantines
Drugs for Methylxanthines end in
“ophylline”
Anti-inflammatory asthma/COPD:
2 drugs that fall under Methylxanthines class
- Aminophylline
- Theophylline
Aminophylline is administered via
IV
Theophylline is administerd via
oral
Why is Theophylline is considered a dangerous drug?
- Has a narrow therapeutic level
- Even small increases in dose can result in toxicity, leading to severe side effects.
Methylxanthines Class:
Therapeutic level for Theophylline
10-20 ng/mL
Methylxanthines Class:
4 Signs of Theophylline Toxicity
- N/V
- Seizures
- insomnia
- changes in mental status
Daily Medication chart:
What med is used for QUICK-RELIEF on ALL PATIENTS.
SABA
Daily Medication chart:
SABA is used as ___.
needed for symptoms
Daily Medication chart:
SABA: intensity of treatement depends on
SEVERITY of symptoms.
Daily Medication chart:
Administration of SABA treatments
up to 3 treatments at 20 minute intervals as needed.
Daily Medication chart:
What other medication may be given with SABA quick relief?
Corticosteroids may be needed.
Q: What frequency of SABA use (for symptom relief) suggests INADEQUATE asthma control?
Using a SABA > 2 days a week indicates the need for improved treatment management.
Step 1: Prefereed medication for Asthma management
SABA (as needed)
STEP 2: Preferred med & its Alternative
Preferred: Low dose ICS
Alternative: LTRA or Theophylline
4 main S/S of asthma
- Tripod posture
- Cough
- Accessory muscle use
- Increased respiratory rate
- Hypoxemia: low O2 levels
2 assessments that are VITAL to perform for Asthma patients.
- Listening to Breath Sounds Matters!
- Counting Respirations matters (it is a VITAL sign)
KNOW
Asthma:
What does a “silent chest” indicate in a Asthma patient?
- Indicates that the patient may be in status asthmaticus- a medical emergency requiring immediate intervention.
- is dangerous and an ominous sign indicating severe airway obstruction and impending respiratory failure.
6 steps to Manage & Teach patients with Asthma.
- Managed by EARLY treatment and education
- Written asthma action plan
- Quick-acting beta adrenergic agonist medications (SABA)- FIRST
- Systemic corticosteroids if do not respond to SABA medications- SECOND
- Supplemental oxygen if hypoxic
- Peak flow monitoring
What is Status Asthmaticus
- Now its called “Severe life-threatening asthma attack”
- Rapid onset, severe, persistent asthma attack that does NOT respond to usual treatment
- High risk for respiratory failure
- Pt usually ends up on ventilator
S/S of Status Asthmaticus
Same as sever Asthma with:
* PROLONGED exhalation
* Distended Neck Veins
* Wheezing -as obstruction worsens, wheezing may disappear = impending resp. Failure!!! **
Assessments & Dx findingsfor Status Asthmaticus
- Ability to talk
- LOC
- Positioning
- ABGs: LOW PaCO2 in beginning due to increased breathing
Most common diagnostic findings for Status Asthmaticus
ABGs: LOW PaCO2 (in beginning)
(plus increased PH= respiratory ALKALOSIS)
As Asthma gets worse ABGs change.
HIGH PoCO2 (can become normal levels)
and
DECREASED PH
* increased PaCO2 bc they can’t breath it out.
* Both of these reflecting Respiratory ACIDOSIS = signals IMPENDING RESP. FAILURE.
Medical mgmt of Status Asthmaticus:
After administering SABAs (inhaled), systemic corticosteroids, and supplemental oxygen for hypoxia in status asthmaticus, what additional medication may be given, and at what dosage if did NOT respond to the initial tx.
- Magnesium sulfate: help relax bronchial smooth muscle and reduce airway resistance
- Single dose over 20 minutes
-all of this can cause flushing, tingling, CNS depression, respiratory depression, hypotension
Medical mgmt of Status Asthmaticus:
Adverse effect of Magnesium sulfate
- flushing
- tingling
- CNS depression
- respiratory depression
- hypotension
Complications of severe asthma can be caused by
the increased pressures within the pulmonary system
