Asthma Flashcards
What are the common symptoms of an acute asthma episode?
Cough Wheeze Chest tightness Dyspnea Sputum production
In a patient with asthma what signs are you looking for on physical exam?
Wheezing on auscultation of respiratory exam
Nasal polyps
List THREE tests you would do to confirm a diagnosis of Asthma?
Pulmonary function test (Spirometry)
Peak expiratory flow monitory
Bronchoprovocation challenge test (Methacholine, Histamine)
When would you use sputum eosinophil counts in a patient with asthma?
Monitor effectiveness of anti-inflammatory therapy
Guide dosage adjustments in individuals with moderate to sever asthma
How would you advise a patient to prevent episodes of acute asthma exacerbations?
Avoid tobacco/Smoking cessation
Avoid second hand smoke
Avoid triggers/allergens
What are common triggers for asthma? List FIVE
Environment allergens (dust, pollen, pets) Occupational exposures (chemicals) Preservatives (sulfites) Rhinitis Sinusitis Viral respiratory infections Smoking Exercise Drugs - ASA, B-blockers
The results of the spirometry test for your patient returns. The FEV1/FVC=15% post bronchodilator. How would you interpret this result?
Decreased expiratory flow rates.
Pt meets criteria for Asthma (FEV1/FVC≥12% post-bronchodilator) for both adults and children
When would you use Peak Expiratory Flow monitory? How do you interpret the results?
Asthma Dx (PEF≥20% post-bronchodilator) in both adults and children Monitor severe Asthma Patients with poor perception of airway obstruction
What is most important step in the management of newly diagnosed asthma?
Self-management education - written asthma action plan
Describe the stepwise manage of asthma?
- Short-acting B2-agonist (SABA) - Salbutamol
- SABA + inhaled corticosteroid (ICS)
- SABA + ICS + LABA (decrease night Sx, prevent exercised induced bronchospasm)
b) SABA + increase ICS dose
c) SABA + ICS + Leukotriene Receptor Antagonists (LTRA)
4)Add LABA, LTRA or increase ICS dose if not previously done
Theophylline an option in adults only
How do you know if the patient’s asthma is under control?
Daytime Sx
Patient with asthma coming in for follow-up. How would you approach the visit?
Assess control, adherence, inhaler technique, co-morbidities (sinusitis, rhinitis, GERD), environment (mold, carpet, pets)
Spirometry/Positive Expiratory Force
If >18yo with mod-severe asthma then sputum eosinophils
If children - growth chart. Refer to specialist if fall-off
Periodically trial step-down therapy to maintain control at lowest dose
You have a patient who you suspect to have asthma, other than symptoms what else would you ask on history? List FIVE
Pattern of symptoms (seasonal, perennial, diurnal variation)
Precipitating factors (env’t allergens, occupational exposures, viral resp infections, GERD, rhinitis, sinusitis, preservatives-sulfites, irritants-smoke/exercise or drugs-ASA/B-blockers)
Previous ER visits
Hospitalizations
ICU admissions
Candidiasis is a potential side effect of using inhaled corticosteroids, how would you advise your patients to reduce their risk?
Rinse mouth after using
Use a spacer device
24yo female otherwise healthy presents with shortness of breath, unable to speak sentences, confused. Vitals are RR 30/min, HR 120bpm. She is quite cyanotic appearing. Her chest is silent. List SIX signs or symptoms that would meet criteria for admission.
Unable to speak full sentences
Confusion
Abnormal vitals: RR>25/min, HR>110bpm or bradycardia, PEF
