Asthma Flashcards
What cells are involved in an asthma attach?
mast cells, Eosinophils, neutrophils, T-lymphocytes, macrophages, epithelial cells
Can asthma be reversed
yes spontaneously or with treatment
this is a big difference because you can not reverse COPD
what are Asthma risk factors
Innate Immunity
Host factor- genetics
Environment Factors
what are some symptoms of asthma
Wheezing
History of cough thats worse at night, trouble breathing
When do the symptoms of asthma tend to get worse
Exercise Viral infection Inhalant Agents Irritants changes in weather emotional response Stress Menstrual cycles
How is Asthma diagnosed
episodic symptoms of airflow obstruction or hyperresponsiveness
Airflow obstruction is at least partially reversible
FEV1 of >200ml and >or= 12% from baseline measure after SABA
What are the goals of Asthma therapy
Reduce impairment prevent symptoms require infrequent use of SABA maintain norm. pulm function maintain norm. activity levels meet pt's and Fams expectations and satisfaction with asthma care
How do you reduce the risk of asthma with therapy
prevent exacerbations and minimize ED visits
prevent loss of lung function
prevent reduced growth lung growth
provide optimal pharmacotherapy
what drugs belong to SABA beta 2 agonist?
Albuterol
Levabuterol
Pirbuterol
using a SABA more than 2 days a week indicated what
need to begin long term control medications
Ipratropium
Anticholinergic not the preferred agent Can not use in Pts under 12 MDI-2puffs every 6 hours Take longer to work More Side effects
Albuterol & ipratropium combo dosing for
MDI-metered dose inhaled
Neulizer
MDI- 1inh every 6 hours
Neb: 3ml every 6 hours
Why are low does inhaled corticosteroids preferred treatment for step 2
decreased the number and activity of inflammatory cells (better at reducing inflammation from eosinophils& neutrophils
Inhibit bronchoconstrictor mech.
What are the side effects of Inhaled steroids
cough, dysphonia, oral thrush
what are the effects of high does inhaled steroids
Adrenal suppression Osteoporosis skin thinning easy bruising cataracts
what are the effects of low dose inhaled steroids
growth suppression in children
growth velocity may be altered
What are Inhaled corticosteroids
Budesonide Fluticasone Mometasone Ciclesonide Beclomethasone
What are step 2 alternatives to low dose inhaled steroids
age>12
Mast cell stabilizers: cromolyn (now only used via nebulizer)
nedocromil
LTRA(more effective)
montelukast, Zafirlukast
Theyophilline( has a lot of side effects) related to caffeine narrow therapeutic index
How do mast stabilizers work?
stabilize mast cells
block chloride channels
can be used as preventative therapy for exercise unknown allergies
great safety profile but questionable efficacy
What are LTRA drugs
Montelukast or Zafirlukast
they interfere with leukotriene mediators
What are things to watch for with people who are on LTRA
Think they start with L so they affect the liver (ALT)
hepatitis
Can cause depression in children (kids want to jump off a mountain)
How does Zafirlukast interaction and CYP problems
food decreases bioavailability
CYP 2C9 inhibitor
increased warfarin levels
what is theophylline metabolized by?
CYP1A2 & CYP3A4
What is used for step 3 in asthmatics
age>12
Medium dose ICS (1st) or Low dose ICS & LABA or Low dose ICS+LTRA,theophylline, Zeluton
what is really important about using a LABA
it has no anti-inflammatory properties never use as mono therapy
What is the black box warning with LABAs
increased risk of asthma exacerbation and asthma related death with regular use of LABA
what are two kinds of LABAs
Salmeterol and Formoterol (faster think stars with F like F1 race car)
what is so special about mometasone
you only need to take it once
what should be used in Step 4 asthma
age>12
medium dose+LABA
or
Med dose ICS+LTRAorTheophylline, or Zileuton or Tiotropium
what to use with step 5 asthmatics
Age>12
High dose ICS+LABA and consider omalizumab
what to use with step 6 asthmatics
Age>12
High dose ICS+LABA+ oral steroid and consider omalizumab
how does omalizumab work
bind to portion of IgE antibody preventing the binding to its high affinity receptor on mast cells and basophils
what are some adverse effects of omalizumab
urticaria and anaphylaxis
what are some oral steroids
prenisolone, prednisone, methylprenisolone
what are some non-pharmacologic treatment
avoid triggers remove carpet vacuum windows closed air filters
what is the first line treatment for exercise induced bronchospasms
SABA
what is second like for EIB
LTRA
what is the last line for EIB
cromolyn
If a patient has asthma and GERD how do you treat them
treat the GERD because it is often that if you stop it that will relieve the asthma symptoms
what are COPD risk factors
smoking alpha1 antitrypsin occupation air pollution infection socioeconomic status
what is the hallmark of COPD
dyspnea
what are some other classic symptoms of COPD
chronic cough
sputum production
what are the two 24 hour long acting LABA
vilanterol
indacterol
what is a 12 hour acting LABA
arformoterol
Why is tiotropium a better anticholinergic
more selective and has a higher affinity for muscarinic receptor
what has been shown to increase survival in chronic respiratory failure?
oxygen
need to have levels >90%
In COPD patients who experience exacerbations what is first line treatment
oxygen 1st then SABA
2nd line-short acting anticholinergic
steroid
what 3 cardinal symptoms must present for use of antibiotics in an exacerbation
increased dyspnea
sputum volume
sputum purulence
only need two of the 3 symptoms if purulent sputum is one of them or a person on a ventilator
how long do you give the antibiotics for?
7-10 days
what are the nighttime awakenings for intermittent
ages 5yo>
what is their stage?
less than or = 2
Step 1
what are the nighttime awakenings for mild
ages 5yo>
what is their stage?
3-4x/month
step 2
what are the nighttime awakenings for moderate
ages 5yo>
what is their stage?
> 1x/week but not nightly
step 3
what are the nighttime awakenings for severe
ages 5yo>
what is their stage?
7x/week
step 4or5
what are the nighttime awakenings for intermittent
ages 0-4yo
what is their stage?
0
stage 1
what are the nighttime awakenings for mild
ages 0-4yo
what is their stage?
1-2x/month
step 2
what are the nighttime awakenings for moderate
ages 0-4yo
what is their stage?
3-4x/month
step 3
what are the nighttime awakenings for severe
ages 0-4yo
what is their stage?
> 1x/week
step 3
For ages 0-4 what is step 1 asthma treatment
SABA
For ages 0-4 what is step 2 asthma treatment
Low dose ICS
For ages 0-4 what is step 3 asthma treatment
medium dose ICS
For ages 0-4 what is step 4 asthma treatment
medium dose ICS & montelukast or LABA
For ages 0-4 what is step 5 asthma treatment
high dose ICS & montelukast or LABA
For ages 0-4 what is step 6 asthma treatment
High dose ICS & montelukast/LABA & oral steroids
when would you consider stepping down asthma meds
when asthma has been controlled for at least 3 months
what is the treatment for age 5-11 step 1
SABA PRN
what is the treatment for age 5-11 step 2
Low dose ICS
alternate:
LTRA or theophylline
what is the treatment for age 5-11 step 3
med dose ICS or low dose ICS+LABA or LTRA or theophylline
what is the treatment for age 5-11 step 4
med dose ICS+LABA
alternate
med dose ICS+LTRA or theo
what is the treatment for age 5-11 step 5
high dose ICS+LABA
alternate
high dose ICS+LTRA or theo
what is the treatment for age 5-11 step 6
high dose ICS+LABA+ oral steroid
alternate
High dose ICS+LTRA/theo+oral steroid
