Asthma

Question 1

Asthma definition?

Answer 1

OBSTRUCTIVE
Chronic inflamm of airways,
Intermittent obstruction (U) reversible,
Hyper-reactive airway

Question 2

Asthma risk factors?

Answer 2

Hx of atopic dz
Family hx
Tobacco exposure
GERD
RSV
Vocal chord dysfxn

Question 3

Asthma sxs?

Answer 3

dyspnea
cough (> in p.m.)
wheeze
tight chest
exacerbated w/ triggers

Question 4

Asthma initial approach:

New?

Existing?

Answer 4

Establish baseline

New:
nocturnal sxs, risk fxr/triggers, recent URI

Existing:
inhaler frequency, ER visits, hospitalization, intubation, lifestyle Δs

Question 5

Asthma presentation?

Answer 5

Expiratory wheeze
Prolonged expiration
Tachypnea
Tachycardia (U) from abuterol use
Accessory mm use
Atopic dz
Pulsus paradoxus (↓ pulse on inspiration)

Question 6

Asthma initial diag w/ PFT?

Answer 6

> 12% in FEV1 w/ bronchodilator

methacholine challenge: FEV1 ↓ by 20% (can be false +)

Question 7

Asthma monitoring?

Answer 7

spirometry response to tx

Question 8

Asthma classification in steps: Step 1?

Answer 8

intermittent, all ages

sxs < 2/wk
< 5yo
N PFT in b/w sxs
brief exacerbation
FEV1 >80%

Question 9

Asthma classification in steps: Step 2?

Answer 9

mild, persistent

sxs >2/wk
0-4yo: >2 nights/mo
>5yo: 3-4 nights/mo
minor activity limit
FEV1 >80%

Question 10

Asthma classification in steps: Step 3?

Answer 10

moderate, persistent

sxs daily
0-4yo: 3-4 night/mo
>5yo: >1 night/wk
exacerb >2/wk, lasts days, ↓ activity
FEV1 60-80%

Question 11

Asthma classification in steps: Step 4?

Answer 11

severe, persistent

sxs always
0-4yo: >1 night/wk
>5yo: (U) every night
↓↓ activity
FEV1 <60%

Question 12

Asthma meds?

Answer 12

B2 agonists (short and long acting) SABA, LABA

Corticosteroids (inhaled or systm) ICS, SCS

Anticholinergics

Leukotriene Receptor Antagonists (LTRA)

Question 13

Tx for Step 1, children?

For Step 2, children?

Answer 13

short B2 agonists PRN

low-dose ICS + SABA

Question 14

Tx for Step 3, children?

Answer 14

refer
0-4yo: med-dose ICS
5-11yo: med-dose ICS OR low ICS + LTRA/LABA

Question 15

Tx for Step 4, children?

Answer 15

0-4yo: med-dose ICS + LABA/LTRA

5-11yo: med-dose ICS OR low ICS + LABA

Question 16

Tx for Step 5, children?

Answer 16

0-4yo: high-dose ICS + LABA/LTRA

5-11yo: high-dose ICS + LABA

Question 17

Tx for Step 6, children?

Answer 17

all ages: high-dose ICS + LABA + oral steroids

Question 18

Assessing asthma control, children: Rule of 2s

Answer 18

Rule of 2s:
>2/wk,
>2 nights/mo,
quick meds >2/wk

Question 19

Well-Controlled in children =

Answer 19

<1 night/mo

Question 20

Not Well-Controlled in children =

Answer 20

0-4yo: >2/wk, >1 night/mo

5-11yo: >2/wk, >2 night/mo

Question 21

Poorly Controlled in children?

Answer 21

All: throughout day
0-4yo: >1 night/mo
5-11yo: >2 night/mo

Question 22

Tx for Step 1, adults:

Controller?

Rescue?

Answer 22

Controller: Φ

Rescue: SABA (albuterol)

Question 23

Tx for Step 2, adults:

Controller?

Rescue?

Answer 23

Controller: low-dose ICS OR LTRA

Rescue: SABA (albuterol)

Question 24

Tx for Step 3, adults:

Controller?

Rescue?

Answer 24

Controller: low-dose ICS + LABA (advair)
OR med-dose ICS

Rescue: SABA (albuterol)

Question 25

Tx for Step 4, adults:

Controller?

Rescue?

Answer 25

Controller: med-dose ICS + LABA (advair)
OR med-dose ICS + LTRA/theophyl

Rescue: SABA (albuterol)

Question 26

Tx for Step 5, adults:

Controller?

Rescue?

Answer 26

Controller: high-dose ICS + LABA (advair)
AND Xolair for allergies

Rescue: SABA (albuterol)

Question 27

Tx for Step 6, adults:

Controller?

Rescue?

Answer 27

Controller: high-dose ICS + LABA (advair) + oral steroids
AND Xolair for allergies

Rescue: SABA (albuterol)

Question 28

Acute asthma attack: Peak Expiratory Flow predicts severity

Mild?

Mod?

Severe?

Emergency?

Answer 28

Mild: PEF >70% (outpt)

Mod: PEF 40-69% (ER)

Severe: PEF <25% (ICU)

Question 29

Acute asthma attack: ABG findings?

Answer 29

(C): resp alkalosis from hypervent/hypocapnia

Ominous: normal Pco2, tired pt

Question 30

Acute asthma attack: ECG monitoring?

Answer 30

watch for long QT interval (hypoK+ from B-agonist use)

Question 31

Acute asthma attack: tx?

Answer 31

Small Vol nebulizer (albuterol)
Oral/IV steroids if PEF <50%
Abx only for penumonia
Resp monitoring
Intubation