Asthma Flashcards
Asthma Definition
- chronic inflammatory dz of the airways w/:
- -airway obstruction that may or may not be reversible either spontaneously or with medication
- -inflammation caused by cellular components
- -increased airway hyper responsiveness
- -airway remodeling
Pathophysiology Asthma
- inhale trigger leading to rapid bronchospasm
- mast cell degranulation and recruitment of histamine and leukotrienes (cellular components)
- late response (inflammatory cells) leading to chronic inflammation.
Common allergens/irritants/triggers leading to asthma exacerbation
Allergens:
- dust mites
- pet dander
- rodents
- mold
Irritants:
- smoke
- strong fumes
- chemicals
- VOCs (volatile organic cmpd)
Triggers:
- tobacco
- exercise
- GERD
- chronic sinus dz
What is samter triad?
- aspirin/NSAID sensitivity, allergic rhinitis w/ nasal polyps, asthma
aka: aspirin sensitive asthma
Presentation of pt with Aspirin Sensitive asthma?
-malaise, rhinorrhea, bronchospasm, productive cough, ocassionally angioedema with in 20-30min of Aspirin or NSAID ingestion.
Dx of asthma
- timeline; persistent cough
- cough worse at night, awakes pt at night
- cough that interferes with activities such as sports/recreational playing
- recurrent wheeze, SOB
- recurrent URI.
- clear trigger: exercise, cold air, alleren
- Allergic child (atopic dermatitis, allergic rhinitis)
- FHx: especially maternal
- Clear lung sounds
- PE:
- -allergic shiners, late stages clubbing
- -Tripod breathing
- -tachypnea
- hypoxemia
- retractions
- wheezing; inspiratory and expiratory
- Spirometry* (confirms variable expiratory airflow limitation)
- responds to bronchodilator challenge (reversibility FEV1 greater than or equal to 12% and 200mL)
Look at Asthma classification charts.
Look at Medication algorithm.
Thanks. :)
What are the short acting/rescue meds for asthma?
SABA:
-albuterol, xopenex, maxair
other:
-short acting anticholinergic = ipatropium bromide
What are recommended ICS for:
- 12+ YO
- 4+ YO
- 1+ YO
12- Advair (fluticasone/salmeterol MDI)
4- Flovent (Fluticasone, MDI)
1- Pulmicort (Budesonide)
Leukotriene Blockers
- med name
- MOA
med: Singulair (Montelukast)
MOA: inhibits inflammation by blocking leukotriene cells.
Asthma Management
- Asthma action plan
- -red yellow green, medications, when to use
- peak flow
- F/U every 3-6mo
- EDUCATION!!!!!!!
- Step down therapy*
who qualifies for Dry Powder inhaler? (DPI)
those who can correctly perform PFTs. (7-8yo)
What is included in a asthma action plan?
AAP is a written plan of care from health care provider with guidelines for treating asthma sx
-includes medication information, usual triggers, special instructions
Green zone sx
Yellow zone sx
Red zone sx
Green: no asthma sx, 80% of personal best of peak flow
Yellow: coughing, wheezing, chest tightness, SOB, 50-80% best of peak flow
Red: Diff talking, walking, or drinking, nasal flaring when inhaling. yellow sx that is not relieved from medications. Lower than 50% of best peak flow.
*Call 911
ED management of Asthma exacerbation
-3 back to back neb tx w/ albuterol and atrovent (ipatropium bromide)
Oral steroids
if showing improvement…D/C.
If not improving Admit to hospital.
