Asthma Flashcards
Asthma definition?
OBSTRUCTIVE
Chronic inflamm of airways,
Intermittent obstruction (U) reversible,
Hyper-reactive airway
Asthma risk factors?
Hx of atopic dz Family hx Tobacco exposure GERD RSV Vocal chord dysfxn
Asthma sxs?
dyspnea cough (> in p.m.) wheeze tight chest exacerbated w/ triggers
Asthma initial approach:
New?
Existing?
Establish baseline
New:
nocturnal sxs, risk fxr/triggers, recent URI
Existing:
inhaler frequency, ER visits, hospitalization, intubation, lifestyle Δs
Asthma presentation?
Expiratory wheeze Prolonged expiration Tachypnea Tachycardia (U) from abuterol use Accessory mm use Atopic dz Pulsus paradoxus (↓ pulse on inspiration)
Asthma initial diag w/ PFT?
> 12% in FEV1 w/ bronchodilator
methacholine challenge: FEV1 ↓ by 20% (can be false +)
Asthma monitoring?
spirometry response to tx
Asthma classification in steps: Step 1?
intermittent, all ages
sxs < 2/wk < 5yo N PFT in b/w sxs brief exacerbation FEV1 >80%
Asthma classification in steps: Step 2?
mild, persistent
sxs >2/wk 0-4yo: >2 nights/mo >5yo: 3-4 nights/mo minor activity limit FEV1 >80%
Asthma classification in steps: Step 3?
moderate, persistent
sxs daily 0-4yo: 3-4 night/mo >5yo: >1 night/wk exacerb >2/wk, lasts days, ↓ activity FEV1 60-80%
Asthma classification in steps: Step 4?
severe, persistent
sxs always 0-4yo: >1 night/wk >5yo: (U) every night ↓↓ activity FEV1 <60%
Asthma meds?
B2 agonists (short and long acting) SABA, LABA
Corticosteroids (inhaled or systm) ICS, SCS
Anticholinergics
Leukotriene Receptor Antagonists (LTRA)
Tx for Step 1, children?
For Step 2, children?
short B2 agonists PRN
low-dose ICS + SABA
Tx for Step 3, children?
refer
0-4yo: med-dose ICS
5-11yo: med-dose ICS OR low ICS + LTRA/LABA
Tx for Step 4, children?
0-4yo: med-dose ICS + LABA/LTRA
5-11yo: med-dose ICS OR low ICS + LABA
Tx for Step 5, children?
0-4yo: high-dose ICS + LABA/LTRA
5-11yo: high-dose ICS + LABA
Tx for Step 6, children?
all ages: high-dose ICS + LABA + oral steroids
Assessing asthma control, children: Rule of 2s
Rule of 2s:
>2/wk,
>2 nights/mo,
quick meds >2/wk
Well-Controlled in children =
<1 night/mo
Not Well-Controlled in children =
0-4yo: >2/wk, >1 night/mo
5-11yo: >2/wk, >2 night/mo
Poorly Controlled in children?
All: throughout day
0-4yo: >1 night/mo
5-11yo: >2 night/mo
Tx for Step 1, adults:
Controller?
Rescue?
Controller: Φ
Rescue: SABA (albuterol)
Tx for Step 2, adults:
Controller?
Rescue?
Controller: low-dose ICS OR LTRA
Rescue: SABA (albuterol)
Tx for Step 3, adults:
Controller?
Rescue?
Controller: low-dose ICS + LABA (advair)
OR med-dose ICS
Rescue: SABA (albuterol)
Tx for Step 4, adults:
Controller?
Rescue?
Controller: med-dose ICS + LABA (advair)
OR med-dose ICS + LTRA/theophyl
Rescue: SABA (albuterol)
Tx for Step 5, adults:
Controller?
Rescue?
Controller: high-dose ICS + LABA (advair)
AND Xolair for allergies
Rescue: SABA (albuterol)
Tx for Step 6, adults:
Controller?
Rescue?
Controller: high-dose ICS + LABA (advair) + oral steroids
AND Xolair for allergies
Rescue: SABA (albuterol)
Acute asthma attack: Peak Expiratory Flow predicts severity
Mild?
Mod?
Severe?
Emergency?
Mild: PEF >70% (outpt)
Mod: PEF 40-69% (ER)
Severe: PEF <25% (ICU)
Acute asthma attack: ABG findings?
(C): resp alkalosis from hypervent/hypocapnia
Ominous: normal Pco2, tired pt
Acute asthma attack: ECG monitoring?
watch for long QT interval (hypoK+ from B-agonist use)
Acute asthma attack: tx?
Small Vol nebulizer (albuterol) Oral/IV steroids if PEF <50% Abx only for penumonia Resp monitoring Intubation
