Asthma Flashcards
What 3 treatments should immediately be started in a patient suffering a severe acute asthma exacerbation?
Oxygen therapy, high doses of an inhaled beta-2 agonist, and systemic corticosteroids.
Asthma symptoms may occur spontaneously or precipitated or exacerbated by many different triggers including:
Allergens, exercise, URIs, rhino sinusitis, postnatal drip, aspiration, occupational exposure, cigarette smoke, GERD, changes in weather, and stress.
What are the two strongest identifiable predisposing factors for the development of asthma?
Atopy and obesity
Asthma is characterized by what patient complaints?
Episodic wheezing, difficulty in breathing, chest tightness and cough.
True/false: asthma symptoms are usually worse in the day and better at night.
False. Worse at night between 3-4am when bronchial reactivity peaks
What Physical exam findings increase the probability of asthma?
Nasal muscosal swelling, secretion increases, and polyps are often seen in patients with allergic asthma
True/false. Wheezing during forced expiration is a sign of airflow obstruction.
False. Wheezing during normal expiration is
What diagnostic tool helps clinicians determine the presence and extent of airflow obstruction and whether it is immediately reversible?
Spirometry. Before and after the administration is a short-acting bronchodilator.
What is a tool that can be used to help confirm the asthma diagnosis and identify environmental and occupational causes of symptoms?
Peak exploratory flow (PEF). Handheld devices designed as personal monitoring tools
What time of day are PEF values the most useful?
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.
When is a CXR indicated for asthma?
When pneumonia or pneumothorax is suspected.
What are the major complications from asthma?
Exhaustion, dehydration, airway infection, and tussock syncope.
Rarely: pneumothorax
What is a common finding on a spirometry with a patient with asthma?
concave-shaped flow-volume curve
On an arterial blood gas, a CO2 level is rising, what could this be an indication of?
A need for mechanical ventilation
What is pulsus paradoxus?
A >10mmHg fall in systolic pressure on inspiration
What severity of asthma attack is a patient having if pulsus paradoxus is present and is >25mmHg?
Severe!
Asthma is most common in which demographic?
Male children and female adults. Hospitalization and death rates highest in blacks and children.
True/false. Selected individuals may experience asthma symptoms after exposure to aspirin or NSAIDs.
True!
True/False. Asthma can be predicted by certain times in the menstrual cycle.
True!
What is cardiac asthma?
Wheezing precipitated by decompensated heart failure
If patient responds to therapy, is a CXR indicated?
No, probably not due to other cause beside asthma
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?
mild
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?
SEVERE
What type of asthma attack is a patient having if their PEF is 42% and they have trouble breathing when supine?
Moderate
What are signs of a patient’s asthma attack showing respiratory arrest is imminent?
They aren’t talking, they appear drowsy or confused, wheezes are absent, bradycardia, PEF 42
What are the 2 components taken into consideration when assessing asthma control?
Impairment - frequency and intensity of symptoms and functional limitations
Risk - likelihood of acute exacerbations or chronic decline in lung function
T/F. Some patients may have minimal impairment yet remain at risk for severe exacerbations.
True, like if have a upper respiratory infection
Which asthma patients should have a written asthma action plan?
ALL asthma patients! Especially those with poorly controlled symptoms or history of severe exacerbations
What are the 3 drug classes that are used for long-term asthma control?
Corticosteroids, long-acting bronchodilators, and leukotriene modifiers.
What does NAEPP 3 emphasize as the cornerstone of treatment of persistent asthma?
daily anti-inflammatory therapy with inhaled corticosteroids.
What vaccinations are indicated in asthma patients?
seasonal flu shot and pneumococcal vaccinations
T/F: Infections with viruses (rhino) and bacterial (mycoplasma, chlamydia) predispose acute exacerbations of asthma and may underlie chronic, severe asthma
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.
If a patient is having a mild-moderate acute attack what is the stepwise approach?
- measure PEF - values of 50-79% indicate need for quick relief medication. If below 50, need immediate medical care.
- initiate treatment of SABA - up to 2 treatments 20 minutes apart of 2-6 puffs
If patient has a good response to inhaled SABA (no more wheezing or dyspnea and PEF >80%) what do you do next?
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.
If patient has incomplete response to inhaled SABA (persistent wheezing and dyspnea) and PEF is still 50-79%, what do you do next?
Add oral systemic corticosteroid, continue inhaled SABA, contact clinician urgently for further instruction.
If patient has poor response to inhaled SABA (marked wheezing and dyspnea, PEF <50), what do you do next?
Add oral systemic corticosteroid, repeat inhaled SABA immediately, Call doctor AND PROCEED TO ED! (consider calling 911!!)
In the emergency room setting, what is the best predictor of the need for hospitalization?
Response to initial treatment. Better than severity of exacerbation
Asthma hospitalization rates are highest amongst:
blacks and children
