Asthma Flashcards
Describe the most important risk factor for asthma?
Atopy: state of having IgE antibodies to specific allergens
Higher ____ levels, family history, and greater number of _____ increases risk of asthma?
IgE and allergens
Name things that can increase risk of asthma?
Dust mites, alternaria mold, cockroach allergens, cat and dog dander, smoking, excessive hygiene, obesity, environmental factors
3 reversible causes of asthma and size of airways it takes place in?
Airway hypersensitivity, obstruction, inflammation.
When an allergen is encountered, T-helper cells release cytokines, which cause these to travel to airways?
Basophils, eosinophils, mast cells, leukocytes
Inflammation damages structural integrity and can result in this?
Long term remodeling of airway leading to resistance to future treatments.
These are released from mast cells when antigens are crossed linked with IgE?
Histamine, prostaglandin D2, and leukotriene C4. TNF alpha which causes bronchoconstriction
Eosinophils release these inflammatory mediators?
Major basic proteins- bronchoconstriction. Leukotrienes- bronchoconstriction and mucus
Three symptoms of astham?
Cough, wheezing, dyspnea
“Poor perceivers” of this usually require more emergent care?
Dyspnea
This sign may disappear during sever exacerbations and has a prolonged expiratory phase I
Wheezing
Name high risk patients?
Previous admission or intubation for asthma, 2 or more hospitalizations over 12 months, 3 or more ED visits over 12 months, hospitalized in previous 30 days for asthma, >2 rescue inhalers per month, “poor perceivers”, 2 or more PO steroids rx last 12 months.
Treatment of exercise induced bronchoconstriction?
rescue inhaler 10 mins prior to excercise
NSAIDs inhibit ______ and increase release of _______ causing bronchoconstriction?
cyclooxygenase adn leukotriene
Samter’s triad or ASA triad?
Asthma, ASA sensitivity, nasal polyps
Vital signs of astham?
Tachypnea, tachycardia, fever. RR >40 severe obstruction
Make sure to observe these 3 things during physical examination
Mentation, posture, breathing
Examples of obstructive disease?
Asthma, chronic bronchitis, bronchiactasis, emphysema
Examples of restrictive diseases?
Restriction of chest wall with healthy lungs (obesity, neuromuscular disorders), Acute or chronic restrictive disorders (ARDS, Pneumoconiosis, interstitial fibrosis, sarcoidosis)
PFTs measure
Lung volume, airflow, airway reactivity
FVC
Forced vital capacity: total volume of gas that can be exhaled after a full inspiration. Decreased in restrictive and obstructive disorders
FEV1
Forced expiratory volume: volume of gas forcefully exhaled in 1 second after taking full inspiration. reflects resistance in large and medium airways
Most sensitive indicator of small airway disease
FEF (forced expiratory flow) 25-75%
This test result is seen on PFT when an asthmatic uses a SABA and repeats the test?
FEV1 is increased by 12%
This test is performed when asthma is in question but there is a normal PFT?
Methacholine challenge test. Should see decrease in FEV1
What would indicated poor control on asthma control test (ACT)?
= 19
Stepwise approach for managing asthma?
- SABA 2. low dose ICS 3. low dose ICS + LABA or M dose ICS 4. M dose ICS + LABA 5. H dose ICS + LABA and consider omalizumab 6. h dose ICS + LABA + oral cortico and consider omalizumab
B2 agonist effect? Short acting agents?
Bronchodilation and smooth muscle relaxation. Albuterol (90mcg) and levalbuterol (45mcg)
Side effects of SABA?
Tachycardia and tremors
LABA
Salmeterol and Formoterol. NOT used as rescue inhalor or as monotherapy!
ICS actions?
Suppress and reduce inflammation, decrease symptoms and exascerbations, reduce hyperreactivity of airways, improve lung function
ICS: metered dose inhalers (MDI)
Ciclesonide (80, 160mcg) Fluticasone propionate (44, 110,220 mcg) beclomethasone dipropionate (40, 80mcg)
ICS: powder formulations
Mometasone furoate (110, 220mcg) Fluticasone propionate (50, 100, 250 mcg) budesonide (90,180mcg)
ICS-nebulized
Budesonide (0.25mg/2mL, 0.5mg/2mL, 1mg/2mL)
Anticholinergics
Ipratropium- short acting, titotropium- long acting
These medications can be used in mild persistent asthma, or as adjunct to other treatments, but not as effective as ICS or LABAs?
Leukotriene modifiers: montelukast, zafirlukast, pranlukast, zileuton
Phosphodiesterase inhibitor that posseses anti-inflammatory activity but must be monitored because of toxicity?
Theophylline
Patients on Omalizumab must meet these characteristics?
Over the age of 12, moderate to severe asthma, not controlled on H dose ICS, total serum IgE 30-700, demonstrated allergic skin test sensitivity
