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Pulmonology > Asthma > Flashcards

Asthma Flashcards

1
Q

How do you successfully manage Asthma?

A
  • routine monitor of lung function ***
  • patient education
  • environmental factors
  • Pharm
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2
Q

Asthma Definition & pathophys

A

-variable and recurring sx, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation.

Pathophys:

  • breakdown of airway epithelium
  • collagen deposition in basement membrane
  • airway edema
  • as cell activation and inflamm mediators take over
  • chronicity of disease remodels the lungs over time.
  • airflow limitations
  • -airflow limitations:
  • bronchoconstriction
  • airway hyperresponsiveness
  • airway edema (mucus hypersecretions, thick mucus plugs)
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3
Q

WHat is asthma characterized by?

A

-episodic, reversible bronchospasm resulting from an exaggerated bronchoconstrictor response to stimuli,

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4
Q

What are some common irritants of Asthma?

A

-cold air, emotional upset, exercise, cigarette smoke, dust mites, cockroaches, cats, seasonal pollens, animal dander

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5
Q

What cells are involved during an asthmatic event?

A
  • Eosinophils
  • Lymphocytes CD4+
  • Mast cells
  • Leukotrienes (potent inflamm mediators, released by basophil) LTD4: profound bronchoconstriction 1000x more potent than histamine
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6
Q

Asthma has early and late phase, describe whats happening on a cellular level.

A

Early: IgE is secreted by plasma cells, mas cell release mediators that contract airway smooth muscle directly (bronchoconstriction)

Late: recruitment of eosinophil, basophil, neutrophil, and Tcells to site of allergen exposure. Dendritic cells also come.

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7
Q

Intrinsic Asthma

  • immune/non-immune?
  • IgE levels
  • When does this develop?
  • Stimuli
A
  • NON-immune
  • IgE levels are normal
  • develops later in life and usually no family history
  • Stimuli:
  • ASA
  • Pulmonary infections
  • Cold
  • Physiological stress
  • Exercise
  • Inhaled irritants (tobacco)
  • GERD**
  • Post nasal drip
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8
Q

What is Samters triad?

A

-nasal polyps, asthma, ASA allergy

-complex medical condition that causes pts to have asthma, chronic sinusitis, and nasal polyps
“asprin-sensitive asthma”

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9
Q 
Extrinsic Asthma 
-initiated by what?
-when does this develop?
-IgE level
-
A
  • initiated by:
  • Type 1 Hypersensitivity Rxn:
  • Atopy(predisposition)
  • Occupational asthma
  • Allergic bronchopulmonary aspergillosis
  • develops in first two decades of life
  • elevated serum IgE & eosinophil
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10
Q

Exercise induced Asthma

  • pathophys
  • prophylaxis
A
  • heat and water is dripped down the bronchotracheal tree, gets exaggerated if they are in cold leading to increased bronchospasm.
  • Beta-Agonist 10-15minutes before activity, avoid cold air if possible, warm up really well before they start exercise.
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11
Q

Classic Triad of Asthma Sx, what are some other associated sx

A
  • persistent wheeze (expiratory)
  • chronic episodic dyspnea
  • chronic cough (worse at night)

Associated sx:

  • tachypnea, tachycardia
  • prolonged expiration, wheeze
  • sputum production
  • chest pain/tightness
  • hemoptysis
  • diminished breath sound during acute exacerbations
  • pulses paradoxus (also occurs with cardiac tampanode, pericarditis, and sleep apnea)
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12
Q

DDX of Asthma

A
  • COPD
  • Anaphylaxis
  • foreign body ingestion
  • PE
  • CHF
  • Panic disorder
  • Pneumonia
  • Alpha1-Antitrypsin deficiency
  • GERD** (esp sx at night, could start taking prilosec and see if it goes away, will c/o heartburn)
  • Sarcoidosis** young black american female, fibrotic lungs, hilar thickening on xray,
  • vocal cord dysfunction
  • Cough 2ndry ACE inhibitors
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13
Q

WHat are some anaphylaxis sx you wouldnt see in asthma?

A

-edema(facial), sweating, hives, itching, low BP.

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14
Q

Asthma with Hemoptysis DDX

A
  • Allergic bronchopulmonary aspergillosis
  • Bronchiectasis
  • Lung Carcinoma
  • TB

*any blood warrants a chest XRAY

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15
Q

Sx of asthma worsen in the presence of? (Triggers)

A
  • exercise
  • viral infection
  • inhalant allergens and irritants
  • changes in weather
  • strong emotion expression
  • stress
  • menstrual cycles
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16
Q

WHat is needed to establish a dx of asthma?

A

-spirometry

17
Q

Describe the PFT’s of asthma

  • FEV1
  • FEV1/FVC

PFT must reveal that the disease is _____.

How to establish reversibility?

A

FEV1- decreased, less than 80% predicted

FEV1/FVC- less than 65% (70%)

  • must reveal that the disease REVERSIBLE!!
  • FEV1 increase of greater or equal to 12% and at least 200ml after using a short acting B2 agonist.
18
Q

When is the Methacholine or histamine challenge test done?

A
  • done when asthma is suspected but PFT’s are near normal.
19
Q

Diagnostic Test of Asthma

A
  • CXR; will help to rule out pneumonia, CHF, pneumothorax, and airway lesion
  • GE refulx assessment (if have bad taste in their mouth, worse at night)
  • Skin tests: demonstrate atopy
  • Blood Tests: Eosinophils an IgE elevations (these support dx, absence does not exclude asthma)
20
Q

Global Strategy for asthma and prevention

A
  • control sx
  • prevent exacerbation
  • maintain pulmonary function close to normal levels
  • maintain normal activity levels
  • avoid advers effects from asthma meds
  • Prevent development of irreversible airflow limitation
  • prevent asthma mortality
  • routine follow-up visits (q 6mo)
21
Q

WHat are the aspects that should be assessed at each visit?

A
  • signs and sx
  • pulmonary function
  • quality of life
  • exacerbations
  • adherance with tx and side effects
  • patient satisfaction with care
22
Q

Need to assess sx, what are some key question to ask?

A
  • asthma awakened you at night or in early morning?
  • have you needed your quick-acting relief medication more than usual?
  • Have you needed any unscheduled care for your asthma? (ER visits, office visit)
  • have you been able to participate in school/work and recreational activities as desired?
  • Has your peak flow been lower than your personal best?
23
Q

What is an Asthma Action plan and what is used to construct it?

A

-uses peak flow (PEF) values to provide specific directions for daily management and for adjusting medications in response to increasing sx or PEFR.

24
Q

Purpose of Peak Flow

A
  • monitor airway obstruction
  • alter long term therapy for control of sx
  • Have plan in place for using peak flow info to intervene early in exacerbations.
25
Q

What are the 4 classifications of Asthma?

A
  • Intermittent
  • Mild persistent
  • Moderate persistent
  • sever persistent.
26
Q

Intermittent Asthma

  • symptoms
  • nighttime awakenings
  • short acting B2 agonist use for symptom control
  • interference w/ normal activity
  • lung function
  • step #
  • tx
A
  • sx: less than 2 days per week (daytime), 1 or no exacerbations/year requiring oral glucocorticoids
  • nighttime awakenings 2 or few per mo
  • Short acing B2 agonist use for sx control: few than 2x/week
  • interference w/ normal activity: no interference with normal activity
  • lung function: FEV1 normal between exacerbations, FEV1/FVC normal
  • Step # 1
  • Tx: SABA
27
Q

Mild persistent asthma

  • symptoms
  • nighttime awakenings
  • short acting B2 agonist use for symptom control
  • interference w/ normal activity
  • lung function
  • step #
  • tx
A
  • symptoms- >2days/week, not daily , 2 or more exacerbations/year requiring oral glucocorticoids
  • nighttime awakenings- 3-4x/mo
  • short acting B2 agonist use for symptom control- >2day/week, not daily or >1x/day
  • interference w/ normal activity- minor limitation
  • lung function- FEV>= 80% predicted, FEV1/FVC normal
  • step #2
  • Tx: Low dose ICS + SABA OR cromolyn or leukotriene inhibits
28
Q

Moderate Persistent Asthma

  • symptoms
  • nighttime awakenings
  • short acting B2 agonist use for symptom control
  • interference w/ normal activity
  • lung function
  • step #
  • tx
A
  • symptoms- daily, 2 or more exacerbations/year requiring oral glucocorticoids
  • nighttime awakenings- >1x/week, not nightly
  • short acting B2 agonist use for symptom control- daily

-interference w/ normal
activity- some limitation

  • lung function- FEV >60% but less than 80% predicted, FEV1/FVC 95-99%
  • Step 3

Tx: SABA + Low dose ICS + LABA or Medium dose ICS, OR theophylline
*consider refer to specialist

29
Q

Severe Persistent Asthma

  • symptoms
  • nighttime awakenings
  • short acting B2 agonist use for symptom control
  • interference w/ normal activity
  • lung function
  • step #
  • tx
A
  • symptoms- throughout day, 2 or more exacerbations requiring oral glucocorticoids per year,
  • nighttime awakenings- often 7x/week
  • short acting B2 agonist use for symptom control- several times/day
  • interference w/ normal activity- extremely limited
  • lung function- FEV1 less than 60% predicted and FEV1/FVC less than 95% of normal.
  • step # 4 or 5
  • consider short course of oral systemic corticosteroids

Tx: SABA+
Step 4: medium dose ICS + LABA
Step 5: High dose ICS + LABA + consider omalizumab
Step 6: High dose ICS + LABA + oral glucocorticoid OR theophylline

30
Q

Status Asthmaticus

  • what is this
  • presentation
A

-sever bronchospasm that is unresponsive to routine there, may be sudden and rapidly fatal.

Presentation

  • difficulty talking
  • using accessory muscle for inspiration
  • orthopnea
  • diaphoresis
  • mental status changes
31
Q

Tx of Status Asthmaticus

A
  • Oxygen
  • Oximetry
  • ABG’s
  • Peak flow w/ txs of:
  • -inhaled beta 2 agonists
  • -inhaled anticholinergics (works on vagal mediated bronchospasm)
  • -oral or IV corticosteroids
  • if inadequate response to above tx in ER admit to hospital.
  • if good response d/c w/:
  • -inhaled B2 agonist
  • -inhaled anticholinergic
  • -oral corticosteroids x5 days
  • -follow up within 5 days.

Pulmonology (15 decks)

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