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Pulmonology > Asthma > Flashcards

Asthma Flashcards

1
Q

What 3 treatments should immediately be started in a patient suffering a severe acute asthma exacerbation?

A

Oxygen therapy, high doses of an inhaled beta-2 agonist, and systemic corticosteroids.

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2
Q

Asthma symptoms may occur spontaneously or precipitated or exacerbated by many different triggers including:

A

Allergens, exercise, URIs, rhino sinusitis, postnatal drip, aspiration, occupational exposure, cigarette smoke, GERD, changes in weather, and stress.

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3
Q

What are the two strongest identifiable predisposing factors for the development of asthma?

A

Atopy and obesity

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4
Q

Asthma is characterized by what patient complaints?

A

Episodic wheezing, difficulty in breathing, chest tightness and cough.

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5
Q

True/false: asthma symptoms are usually worse in the day and better at night.

A

False. Worse at night between 3-4am when bronchial reactivity peaks

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6
Q

What Physical exam findings increase the probability of asthma?

A

Nasal muscosal swelling, secretion increases, and polyps are often seen in patients with allergic asthma

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7
Q

True/false. Wheezing during forced expiration is a sign of airflow obstruction.

A

False. Wheezing during normal expiration is

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8
Q

What diagnostic tool helps clinicians determine the presence and extent of airflow obstruction and whether it is immediately reversible?

A

Spirometry. Before and after the administration is a short-acting bronchodilator.

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9
Q

What is a tool that can be used to help confirm the asthma diagnosis and identify environmental and occupational causes of symptoms?

A

Peak exploratory flow (PEF). Handheld devices designed as personal monitoring tools

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10
Q

What time of day are PEF values the most useful?

A

PEF should be measured in the morning before administration of a bronchodilator and in the afternoon after taking a bronchodilator. A 20% change suggests inadequate asthma control.
They show diurnal variation and is generally lowest when waking and highest several hours before midpoint of the day.

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11
Q

When is a CXR indicated for asthma?

A

When pneumonia or pneumothorax is suspected.

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12
Q

What are the major complications from asthma?

A

Exhaustion, dehydration, airway infection, and tussock syncope.

Rarely: pneumothorax

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13
Q

What is a common finding on a spirometry with a patient with asthma?

A

concave-shaped flow-volume curve

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14
Q

On an arterial blood gas, a CO2 level is rising, what could this be an indication of?

A

A need for mechanical ventilation

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15
Q

What is pulsus paradoxus?

A

A >10mmHg fall in systolic pressure on inspiration

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16
Q

What severity of asthma attack is a patient having if pulsus paradoxus is present and is >25mmHg?

A

Severe!

17
Q

Asthma is most common in which demographic?

A

Male children and female adults. Hospitalization and death rates highest in blacks and children.

18
Q

True/false. Selected individuals may experience asthma symptoms after exposure to aspirin or NSAIDs.

A

True!

19
Q

True/False. Asthma can be predicted by certain times in the menstrual cycle.

A

True!

20
Q

What is cardiac asthma?

A

Wheezing precipitated by decompensated heart failure

21
Q

If patient responds to therapy, is a CXR indicated?

A

No, probably not due to other cause beside asthma

22
Q

What type of asthma attack is a patient having if they are able to talk in sentences, not using accessory muscles, and are only breathless while walking?

A

mild

23
Q

What type of asthma attack is a patient having if they are having difficulty with conversation at rest, RR >30, and wheezes are heard both on inspiration and expiration?

A

SEVERE

24
Q

What type of asthma attack is a patient having if their PEF is 42% and they have trouble breathing when supine?

A

Moderate

25
Q

What are signs of a patient’s asthma attack showing respiratory arrest is imminent?

A

They aren’t talking, they appear drowsy or confused, wheezes are absent, bradycardia, PEF 42

26
Q

What are the 2 components taken into consideration when assessing asthma control?

A

Impairment - frequency and intensity of symptoms and functional limitations

Risk - likelihood of acute exacerbations or chronic decline in lung function

27
Q

T/F. Some patients may have minimal impairment yet remain at risk for severe exacerbations.

A

True, like if have a upper respiratory infection

28
Q

Which asthma patients should have a written asthma action plan?

A

ALL asthma patients! Especially those with poorly controlled symptoms or history of severe exacerbations

29
Q

What are the 3 drug classes that are used for long-term asthma control?

A

Corticosteroids, long-acting bronchodilators, and leukotriene modifiers.

30
Q

What does NAEPP 3 emphasize as the cornerstone of treatment of persistent asthma?

A

daily anti-inflammatory therapy with inhaled corticosteroids.

31
Q

What vaccinations are indicated in asthma patients?

A

seasonal flu shot and pneumococcal vaccinations

32
Q

T/F: Infections with viruses (rhino) and bacterial (mycoplasma, chlamydia) predispose acute exacerbations of asthma and may underlie chronic, severe asthma

A

true. use of empiric abx is not recommended in routine exacerbations. But abx should be considered when there is fever or purulent sputum and evidence of pneumonia or bacterial sinusitis.

33
Q

If a patient is having a mild-moderate acute attack what is the stepwise approach?

A
  1. measure PEF - values of 50-79% indicate need for quick relief medication. If below 50, need immediate medical care.
  2. initiate treatment of SABA - up to 2 treatments 20 minutes apart of 2-6 puffs
34
Q

If patient has a good response to inhaled SABA (no more wheezing or dyspnea and PEF >80%) what do you do next?

A

contact clinician for follow-up instructions and further management. May continue inhaled SABA every 3-4 hours for 24-48 hours. Consider short course of oral systemic corticosteroids.

35
Q

If patient has incomplete response to inhaled SABA (persistent wheezing and dyspnea) and PEF is still 50-79%, what do you do next?

A

Add oral systemic corticosteroid, continue inhaled SABA, contact clinician urgently for further instruction.

36
Q

If patient has poor response to inhaled SABA (marked wheezing and dyspnea, PEF <50), what do you do next?

A

Add oral systemic corticosteroid, repeat inhaled SABA immediately, Call doctor AND PROCEED TO ED! (consider calling 911!!)

37
Q

In the emergency room setting, what is the best predictor of the need for hospitalization?

A

Response to initial treatment. Better than severity of exacerbation

38
Q

Asthma hospitalization rates are highest amongst:

A

blacks and children

Pulmonology (17 decks)

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