Asthma Flashcards
What do these symptoms indicate:
- wheezing, dyspnea, chest tightness, worsening at night, flare-ups, non-consistent, cough?
asthma
What are the two types of asthma?
atopic (allergic) Type 2 – atopy is the strongest defining factor! more common in children
nonatopic (nonallergic) Non-Type 2 – adulthood, exercise, medication, infection induced
What can put someone at risk for asthma?
children, low income, underserved areas
Atopic triad + Samter’s triad
What’s the atopic triad?
atopic dermatitis, asthma, allergic rhinitis
What’s the samter triad?
aspirin/NSAID sensitivity, asthma, nasal polyps/rhinitis
What disease does this characterize:
hyperactive/hyperresponsive inflammation in response to various triggers –> airway obstruction
REVERSIBLE?
asthma
What can trigger asthma?
- air pollution
- tobacco smoke
- occupational exposures
- mites, animal dander, cockroaches, fungi, mold, pollen
- infections
- diet
- GERD
- exercise induced
- menstruation
- medications (BBs, aspirin)
What does this PE indicate:
nasal polyps, eczema, prolonged expiratory phase, accessory muscle use
asthma
What’s gold standard for asthma diagnosis?
PFTs
<__% FEV1 - obstruction
70%
If FEV1 increases >___% after bronchodilator, = reversibility
12%
What bronchoprovocation testing is a + for asthma?
> 20% decrease in FEV1
using methacholine, histamine
What would you see on an asthmatic xray?
Possibly hyperinflation + air trapping
What would indicate an allergic asthma?
IgE
What’s a normal FEV1/FVC for 8-19yrs?
85%
What’s a normal FEV1/FVC for 20-39yrs?
80%
What’s a normal FEV1/FVC for 40-59yrs?
75%
What’s a normal FEV1/FVC for 60-80yrs?
70%
What values indicate an intermittent asthma severity?
symptoms -
nighttime awakenings -
inhaler use -
interference w/ life -
lung function -
exacerbations -
symptoms - less than 2 days/week
nighttime awakenings - less than 2 times/month
inhaler use - less than 2 days/week
interference w/ life - none
lung function - normal btwn exacerbations, <80% FEV1
exacerbations - 0-1/year
STEP 1
SAPP USES: symptoms <3-5 days/wk w normal or mildly reduced lung function
What values indicate a mild asthma severity?
symptoms -
nighttime awakenings -
inhaler use -
interference w/ life -
lung function -
exacerbations -
symptoms ->2 days/week but not daily
nighttime awakenings - 3-4x/month
inhaler use - >2 days/week but not more than once a day
interference w/ life - minor
lung function - >80% FEV1
exacerbations - greater than/equal to 2 a year
STEP 2
SAPP USES: symptoms <3-5 days/wk w normal or mildly reduced lung function
What values indicate a moderate asthma severity?
symptoms -
nighttime awakenings -
inhaler use -
interference w/ life -
lung function -
exacerbations -
symptoms - most days
nighttime awakenings - >1/week
inhaler use - daily
interference w/ life - some
lung function - >60% but <80% FEV1
exacerbations - greater than 2 a year
STEP 3
SAPP USES: symptoms most days or waking up >1 day/wk. or low lung function
What values indicate a severe asthma severity?
symptoms -
nighttime awakenings -
inhaler use -
interference w/ life -
lung function -
exacerbations -
symptoms - throughout the day
nighttime awakenings - often 7x/week
inhaler use - several times/day
interference w/ life - extreme
lung function - <60% FEV1
exacerbations - greater than 2/year
STEP 4/5
SAPP USES: symptoms daily and waking up >1 day/wk and low lung function. Or recent exacerbation
Every asthmatic should be prescribed a ____, which is ______
rescue inhaler, which is PRN low-dose ICS-formoterol (LABA)
What is treatment for intermittent asthma?
Step 1 -
PRN low dose ICS-formoterol
also could do (from current) = low dose ICS daily + SABA PRN or combo ICS+SABA PRN
What is treatment for mild asthma?
Step 2, which is the same as Step 1
PRN low dose ICS-formoterol
also could do (from current) = low dose ICS daily + SABA PRN or combo ICS+SABA PRN
What is treatment for moderate asthma?
Step 3
combo low dose maintenance ICS-formoterol daily + when needed
What is treatment for severe asthma?
Step 4: combo medium dose ICS-formeterol daily and as needed
Step 5:
medium-high dose ICS-formoterol + LAMA* (current said to also add LABA and SABA PRN if wanted)
How do you treat severe asthma exacerbations?
maintain airway! oxygen + high dose inhaled SABA (albuterol) and can add SAMA (ipratropium) + systemic steroids (metnylprednisolone) + IV magnesium sulfate
consider abx if infections
When should you follow up for reevaluation of asthma treatment?
2-3 months or if patient is not doing well
At what step number do you send an asthma pt to a pulmonologist?
step 5
What improves medication delivery in asthma?
spacer technique
