Asthma Flashcards
What role do leukotrienes play in the inflammatory response for asthma?
potent inflammatory mediators
cause: increased vascular permeability leading to edema
-increased mucus production
-decreased mucociliary transport
-inflammatory recruitment=eosinophils
PROFOUND bronchiocontriction (about 1000x more potent than histamine)
What are the characteristics of asthma?
- -reversible and recurring symptoms
- -reversible airflow obstruction
- -bronchial hyper-responsiveness
- -underlying inflammation
What are the changes that occur with asthma from a persistently inflamed airway? What do these changes contribute to?
–inflammatory cell infiltration (eosinophils, neutrophils, lymphocytes)
–goblet cell hypertrophy
–mucus hypersecretion
–loss of ciliated epithelium
–squamous metaplasia
–destruction of alveolar walls
–peribronchiolar fibrosis
–airway edema
–mast cell activation
ALL of this contributes to airway HYPER-RESPONSIVENESS
What is the pathophysiology of air flow obstruction?
- airflow into lungs can be decreased by airway narrowing = increase resistance
- loss of elastic recoil of the lung = decrease driving pressure
- inflammation of airways
What do repeated bronchiole infections and inflammation lead to?
increased fibroblasts and scarring
actual decrease in pulmonary function
What are the symptoms of asthma in pt history?
cough(chronic)
- wheezing (end expiratory)
- shortness of breath (chronic episodic dyspnea)
- seasonal and/or diurnal variations
What are associated symptoms pt experiences during asthma attack?
- -tachypnea, tachycardia, systolic htn
- -audible harsh respirations, prolonged expiration, wheezing
- -sputum production
- -chest pain or tightness (some pts describe burining, band/like)
- -diminished breath sounds during acute exacerbations
You consider a diagnosis of asthma when the patient is ——– and has a history of?
Wheezing
Hx: chronic cough (worse at night)
–recurrent wheeze
–recurrent difficulty in breathing, recurrent chest tightness
You consider a diagnosis of asthma when the symptoms occur or worsen during?
- exercise
- viral infection
- inhalant allergens and irritants
- changes in weather
- strong emotional expression (crying, laughing)
- stress
- menstrual cycles
- symptoms that occur or worsen at night, awakening the patient
What might you observe on PE of an asthma pt?
- nasal mucosal swelling
- increased nasal secretions
- nasal polyps
- eczema
- atopic dermatitis
- wheezing or prolonged expiratory phase
- body posture
- accessory muscle use
- fragmented speech pattern due to difficulty breathing
Peak flow meters are helpful for?
- determi;ning the degree of airflow limitation
- learning asthma triggers
- determining if the asthma action plan is working
- adjusting medications
- knowing when to seek emergency care
- having an objective measurement of the patients pulmonary status at the time
How can the peak flow be used to build an asthma action plan?
The patients normal peak flow (PEFR) value is used to construct a personalized “asthma action plan,” which provides specific directions for daily management and for adjusting medications in the response to increasing symptoms or decreasing PEFR
What are asthma history questions to assess the degree of control and severity?
- Have you taken oral glucocorticoids w/in last year?
- Have you been hospitalized, intubated (how many hospitalizations w/in last year)
- How many ED visits in last year
- Smoke?
- Increase in symptoms after taking ASA or NSAIDs?
- What is your normal peak flow
- Does your asthma awaken you at night?
- Do you need your quick-acting relief meds more than usual?
- Needed any unscheduled care including calling, office, or ED?
- Unable to participate in school/work and rec activities?
- If you been measuring your peak flow, has it been lower than your best?
What are the goals of asthma treatment?
reduce impairment:
-be “normal” for sports, exercise, work, school
-min need for bronchodilators (less than2x per week)
-optimization of lung function
Reduce risk:
-prevention of recurrent exacerbations
-prevention of reduced lung growth in kinds and loss of lung function in adults
-optimization of meds with minimal or no side effects
What are the classic triad of symptoms for asthma?
wheezing
chronic cough
Chronic episodic dyspnea (shortness of breath)
