Asthma Flashcards
Explain pathophys of Asthma
-Inflammation: asthma irritate the lining of the bronchial tubes, causing them to become inflamed and swollen. excess mucus makes
breathing more difficult
-Bronchoconstriction: bands of muscle surrounding the bronchial tubes contract causing the airway to narrow
Pathophys of air flow obstruction
- air flow into lungs decreased by airway narrowing leading to increase resistance, potential respiratory depression.
- loss of elastic recoil in lung decreasing driving pressure
- inflammation
Contributors in the persistently inflamed airway
- inflamm cell (eosinophils, neutrophils, lymphocytes
- Goblect cell*
- mucus hypersecretion*
- loss of ciliated epithelium*
How do leukotrienes stimulate the inflamm response?
- increased vascular permeability»>edema
- increased mucus production
- decreased mucociliary transport
- LTD4- profoud bronchoconstriction, 1000x more potent than histamine.
Primary problem with asthma?
secondary?
inflamm.
bronchospasm
Characteristics of asthma
- variable and recurring symptoms***
- reversible airflow obstruction***
- bronchial hyper-responsiveness
- underlying inflamm
Asthma Triggers
- common allergens (house dust mites, cockroaches,cat and dog dander, seasonal pollens)
- non-specific: exercise, upper resp. infection, rhinosinusitis and post nasal drip (allergies), aspiiration and GE reflux (GERD), stress, tobacco smoke, aspirin, NSAIDS, hormones
Always obtain good pt Hx. What are some common symptoms of asthma?
- cough* (more likely than wheez)
- wheezing
- SOB
- season/diurnal (night/day)
What time of day would asthma symptoms be the worst and why?
typically between 3-4am d/t low levels of cortisol, more inflammation, eosinophils are most active at this time. Pollen counts are highest at this time too.
Classic Triad of Asthma Symptoms
- wheezing
- chronic episodic dyspnea
- chronic cough
Symptoms during Asthma attack
-tachypnea, tachycardia, systolic hypertension
- harsh respirations, prolonged expiration, wheezing
- air trapping-easier to get air in than out
- chest pain/tightness
- sputum production
- diminished breath sounds
Consider Dx of Ashtma when…
-wheezing or hx of chronic cough (gets worse w/ cold or exercise) or recurrent chest tightness
-Symptoms occur or worsen during.. exercise viral infection inhalant allergens change in weather stress strong laugh or cry menstrual cycles
Red flag sign*** symptoms occur or worsen at night, awakening the patient
Physical Exam finding in Ashtma pt
-usually pretty normal exam (they come in when stable)
- nasal mucosal swelling
- increased nasal secretions
- nasal polyps
- eczema
- atopic dermatitis
- wheezing/prolonged expiratory phase*
- body posture*
- accessory muscle use*
- fragmented speech pattern*
- last 4 require immediate care
- breathless while walking of going up stairs
- able to lie down
- can speak in sentences
- may be agitated
- no sweating
- slightly increase resp. rate
- usually no use of accessory muscles
- moderate wheeze; usually only end-expiratory
Mild Asthma Exacerbation
- breathless on minimal exertion
- prefers sitting
- speaks in phrases
- sometimes agitiated
- sweating
- increased resp. rate
- usually using accessory muscles
- loud wheeze throughout exhalation
Moderate Asthma Exacerbation
- breathless at rest
- hunched forward
- speaking in words
- usually agitated
- sweats profusely
- greater than 30 resp./min
- frequent accessory muscle use
- loud wheeze throughout inhalation and exhalation
Severe Asthma Exacerbation
- unable to speak
- drowsy or confused
- paradoxical thoracoabdominal movements
- weakened or absent wheeze
Respiratory Rest Imminent
Diagnosis of Asthma
- history (symptoms + personal/ family hx of asthma/atopy)
- signs and symptoms suggestive of asthma
- confirmation of variable expiratory airflow limitation, spirometry
- exclusion of alternative diagnoses
Pulmonary function testing
- spirometry**(used to diagnose asthma)
- order before and after bronchodilators, w/o bronchodilator result may be normal. if increase in 12-15% after bronchodilator then asthma.
- Bronchial provocation test
- methacholine challenge, if FEV falls by >20% you have a positive result»>asthma.
- peak flow (dont use this to diagnose asthma, just provides quick measurement)
- used to track asthma symptoms
- measures how fast air comes out of lungs w/ forceful exhalation after inhaling fully
Other asthma diagnostic testing
- chest xray (pneumonia may cause asthma)
- skin testing (helpful for finding allergic triggers)
