Asthma

Question 1

What gene has been found to increase risk of asthma?

Answer 1

ADAM 33 - Metalloproteinase

Question 2

Who are most likely to get asthma?

Answer 2

FamHx and Allergies

– Male young children, but more commonly women are more severely affected into adulthood

Question 3

What age do most children stop experiencing asthma symptoms?

Answer 3

Age 6, if they continue, then more likely to experience eczema, allergic rhinitis, allergic conjunctivitis.

Question 4

What is the biggest risk factor for asthma in adults?

Answer 4

Obesity, especially women

Question 5

What increases a risk for developing asthma in childhood?

Answer 5

• Abx in the first year of life
• smoking during pregnancy / smoke exposure
• C-section
  DECREASED RISK = Daycare, sibilings

Question 6

What exposures increase development of asthma and increased risk of exacerbations?

Answer 6

Environmental allergens/irritants, RSV VIRUS, SMOKE, Air Pollution

Question 7

What are the most common symptoms of asthma?

Answer 7

• Wheezing / SOB – ESPECIALLY NIGHT TIME
• Chronic Cough
• Chest pain with exercise

Question 8

How does exercise induced asthma present?

Answer 8

Usually 5-10 minute after starting and lasting more than 10 minutes after stopping.
- Poor conditioning SOB begins before 5 minutes into exercise and resolves less than 5 minutes after stop

Question 9

How much must FEV1 improve with broncodilators to diagnose asthma?

Answer 9

12% or 200mL, if not then likely COPD

Question 10

What are the different zone system breakdown for asthma?

Answer 10

Green – 80-100% of target peak flow
Yellow – 50-80% of target peak flow
Red –

Question 11

What kind of prevention should a 25 year old asthmatic receive?

Answer 11

Flu Vaccine

Pneumococcal Vaccine

Question 12

If a patient has 2x days of asthma symptoms per week, 2x night symptoms per mouth without symptoms between, what is the severity of the asthma?

Answer 12

Intermittent

• • No intererence with normal activity
• • Normal FEV1 80%+

Question 13

If a patient has daytime symptoms 4 times per week and night time symptoms 1x per week, what is the severity of asthma?

Answer 13

Mild Persistent

• • FEV1 80%+ of predicted
• • Minor limitation in normal activites

Question 14

If a patient has daily daytime asthma symptoms, nighttime symptoms 2 times per week, uses albuterol inhaler daily, what is severity?

Answer 14

Moderate Persistent

• FEV1 60-80%
• FEV1/FVC reduced by as much as 5%

Question 15

If a patient is using their albuterol inhaler on a daily basis, frequent nighttime symptoms, limited physicial acitivty due to symptoms?

Answer 15

Severe Persistent

– FEV1

Question 16

Does increasing an inhaled steriod dose, improve symptom control?

Answer 16

No. Adding long acting B-agonist works better if more symptom control is needed.

Question 17

How do Leukotriene antagonist symptom control compare to inhaled corticosteriods?

Answer 17

Worse. Inhaled Steroids are more effective.

– Leukotriene antagonist is a 2nd line single agent

Question 18

What patients are immunotherapy used best for in asthma?

Answer 18

Patients with a high IgE load

• • Anti-IgE
• • Allergy Shots

Question 19

During an acute exacerbation of asthma, what should be added to nebulizers if they are completely working?

Answer 19

Ipratropium Bromide, systemic steroids can be used as well for 7-10 days to reduce recurrence

Question 20

What is the most important management of long term control of persistent asthma?

Answer 20

Developing a regimen that the patient can maintain normal activity levels and prevent exacerbations. Also having a treatment plan for the patient to adjust accordingly at home.