1. Increased bronchial wall markings/inflammation 2. Flattening diaphragm 3. Chronic inflammation, 4. accessory muscle use 5. Hyperinflation 6. Patchy infiltrates

Asthma Flashcards by Magda S

Asthma characteristics

Bronchoconstriction
Inflammation
Airway remodeling

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Hallmark of asthma

Bronchial wall hyper-responsiveness

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What is the early phase of asthma reaction

Steps

Bronchoconstriction

antigenic stimulation of bronchial wall
mast cell degranulation releases: histamine, chemotactic proteolytics, heparin

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Late phase of asthma

Characteristics

Bronchial inflammation

Cell recruited: neutrophils, monocytes, eosinophils,
Release of cytokines, vasoactive, arachidonic acid
Epithelial & endothelial cell inflammation
Release of interleukin 3-6, interferon gamma

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What is FEV1/FVC

Used in dx of obstructive and restrictive lung disease

Begin to occur at 6 yo, in kids that ddeveloped symptoms by 3 yo.

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Atopy

Genetic predisposition to developing IgE response to common allergens

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What is the classic triad

Asthma
Nasal polyps
Aspirin allergy

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What virus is strongly associate with developing asthma in later years

RSV: respiratory syncytial virus

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What allergies increase risk for asthma

NSAIDS, ASA

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Definition

Reversible Airway obstruction
Airway inflammation
Increased bronchial hyper responsiveness

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What is the % of people that don’t recognize severe symptoms of their asthma

Symptoms accommodators 10%

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What do ace inhibitors induce

Bronchospasm

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Symptoms of asthma

Recurrent wheezes
Dyspnea
Productive or proximal cough
Chest tightness
Prolonged I/E ratio
Atopic eczema, urticaria, dermatitis

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X ray findings

Increased bronchial wall markings/inflammation
Flattening diaphragm
Chronic inflammation,
accessory muscle use
Hyperinflation
Patchy infiltrates

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Labs

ABG: hypoxemia, hypercarbia
CBC: eosinophilia
Increase IgE 
FENO, EBC
Sputum sample

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PFT test

+Metacholine challenge: causes bronchoconstriction

-rules out asthma , + false test

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What is Rule of 2?

> 2x a week during day
2x a month during night
2 inhalers a year
Any present = control is inadequate

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What are the categories of severity

Mild intemittent
Mild persistent
Moderate persistent
Severe persistent

What is the pharmacological management of asthma, the general management strategy.

Corticosteroids-long term
Beta agonists-caution
Rx other factors: GERD, sinusitis
Prevent exercise & cold induced asthma

First line agent & most common for reactive airway

Inhaled corticosteroid

Controls it, no cure, doesn’t modify

What is Xolair?

Immunomodulator
Ant IgE therapy omalizumb: binds to FC portion of IgE antibody to prevent binding to receptors on mast cells
Possible adjunct therapy

Indicated for mild to severe asthma

Leukotriene receptor antagonist

Montelukast (Singular), accolate, zyflo

Atrovent

Anti cholinergic

Rx for peds cold & exercise induced asthma

Mast cell stabilizers
Cromolyn Na (intal), nedocromil (tilade)

ER management for Asthma

1. Short acting beta agonist albuterol | 2. Anticholinergic Atrovent

Indications for systemic corticosteroids

FEV1 or PEF < 50% No immediate response PO Rx taken already

Beta agonist | Use & side effects

Rescue | SE: tachycardia

Adverse effects of inhaled corticosteroids

Dysphonia Candidiasis Glaucoma & cataract risk slightly increased Osteoporosis

What happens with uncontrolled asthma

Reduces linear growth

MOA of leukotriene | Indications

Attentuate bronchoconstriction & inflammation | Mild to mod asthma

Bronchospasm during anesthesia

- 100% O2 - Remove aggregating factors: light anesthesia, allergen, VA, secretion - bronchodilation - Beta agonist - volatile agent

Rx for branchospasm, aggressive

Epinephrine - nebulized SQ 1:1000, 0.1-0.5 mg, may repeat 10-15 min IV 0.1-0.25 mg, single dose MAX 1 mg

Short acting beta agonist

Albuterol Dose: multiple puffs (4-12) via ETT (2 in an awake pt) Each MDI puff = 90 mcq Proventil, ventolin, accuneb

What other med & doses to use for pt status asthmaticus/ bronchoconstriction

Terbutaline - used also for premature labor SQ: 0.25 mg may repeat x 1 IV: 10 mcq/kg over 2-3 min

What are the last considerations

Magnesium sulfate | Heliox: helium + oxygen

Which drug causes dose dependent adrenal suppression?

IV steroids: May & should be given as prophylaxis in steroid dependent patient

What are some glucocorticoid pharm actions

Prolong therapy can atrophy adrenal cortex | Decreased healing diminished protective response to inflammation & immune response to infection

Which group of med causes iatrogenic Cushing's syndrome

Glucocorticoid

MOA of glucocorticoids

Effect mediated by GC receptors | Decreased inflammation & increased capillary permeability

Hydrocortisone dosing

Stress dosing ( replacement) for known adrenal suppressed or on chronic steroids Minor 25 mg/day for 1-2 days Mod 50-75 mg/day for 1-2 days Major 100-150 mg/day for 2-3 days Anti-inflammatory 15-240 mg q 12 Status asthmaticus 1-2 mg/kg q 6h x 24 h

Dose of hydrocortisone for Anti-inflammatory Status asthmaticus

Anti-inflammatory 15-240 mg q12 | Status asthmaticus 1-2 mg/kg q6 x 24hrs

Churg Strauss syndrome is ass with

Leukotrienes

Beta agonist rescue inhalers

Ventolin Albuterol Proventil Accuneb