Asthma Flashcards
Symptoms of Asthma
SOB
Wheezing
Cough
Chest tightness
Risk factors for asthma
smoking
tendency to allergy (dermatitis, allergic rxn)
family history
obesity
lower SES
males in children
females > 40
stress
anxiety
early puberty
What is the main way to diagnose asthma?
spirometer with FEV1 > 80%
What are the short-term triggers for asthma?
COLD air
exercise
emotional stress
What are the long-term triggers for asthma?
allergens
dust, mites
cockroaches
mold, pollen
pet’s danders
Which conditions should be controlled as they may affect asthma exacerbations?
GERD
rhinitis
sinusitis
Non-pharms
warm humidifier
air purifier (no evidence)
avoid emotional stress
exercise
What is FEV1?
It is the forced expiratory volume one second - amount of air a patient can EXHALE in one second.
What is FVC?
Forced vital capacity = total amount of air that the lungs can hold
What is a normal FEV1?
> 80% in adults
What is an indicator of LOW respiratory function?
Severe FEV1 = < 50%
If in doubt, you can do a methacholine test to confirm diagnosis of asthma. What are the steps to this test?
- measure FEV1
- inhale methacholine
- in 15-20 mins, repeat spirometry and measure FEV1. If FEV1 is reduced by > 20% , asthma was triggered by the allergen (methacholine) which caused airway narrowing.
When is peak flow meter used?
can be used to monitor asthma. its used at home, easy for day-today home follow up (i.e. for an asthma action plan)
What is the purpose of using a Chest Xray in asthmatics?
eliminates possibility of TB or lung cancer
What is the ABG test? (Arterial Blood Gas)
determines the need for oxygen therapy; measures lung size, oxygenation, and gas diffusion across alveolar membrane.
normal = SpO2 > 95%
If below < 90%, requires intervention.
Can weight loss help with asthma control?
yes
General sequence of asthma therapy (GINA GUIDELINES)?
- Low dose ICS/LABA prn or SABA prn
- Medium dose ICS/LABA, alternative: LTRA
- PO corticosteroid
- IV corticosteroid
Examples of ICS + LABA
budesonide + formoterol (symbicort)
mometasone + formoterol (Zenhale)
can work both as reliever and controller
What frequency of asthma attacks indicates CONTROLLED asthma?
- Daytime asthma symptoms: ≤2 times per week.
- Night-time waking due to asthma: None.
- Reliever medication use: ≤2 times per week.
- Activity limitation due to asthma: None.
Side effects of SABA
tremors
nervousness
tachycardia
palpitations
weakness
facial flushing/skin
insomnia
N/V
Examples of SABA vs. LABA
SABA: salbutamol, terbutaline
LABA: Formoterol (full b2 agonist), Salmeterol (partial agonist)
Onset of SABA vs. LABA?
SABA: 5 min
LABA: 14 mins but lasts longer (upto 24 hrs). Formoterol has a faster onset compared to salmeterol by 3-5 min
Examples of ICS/LABA combo?
symbicort: budesonide/formoterol
Breo Ellipta: fluticasone/vilanterol
Advair diskus or MDI: luticasone/salmeterol
Zenhale: mometasone/formoterol
side effects of ICS?
oral pharyngeal candidasis
dysphonia
cough
