Asthma Flashcards

1
Q

What is the most common chronic disorder in children and adolescents?

A

Asthma

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2
Q

Define Asthma

A

Recurrent symptoms of airway obstruction that respond to a bronchodilator and often have specific triggers

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3
Q

Second Way to Define Asthma

A

Chronic inflammatory disease of the airways with airway obstruction that’s reversible, airway inflammation, increased airway hyper responsiveness, or airway remodeling

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4
Q

Development of Asthma

A

Genetics
Environment
Airway Inflammation
Bronchoconstriction

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5
Q

Types of Allergens

A
Dust mites
Pet dander
Pollen
Rodents
Mold
Natural oils
Organics
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6
Q

Types of Irritants

A
Smoke
Strong fumes
Pollution
Ozone
Chemicals
Petroleum
VOCs
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7
Q

Other Triggers of Asthma

A
URI
Tobacco
Exercise
Cold air
GERD
Chronic sinus diseaes
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8
Q

Presentation of Asthma and NSAIDs

A
Chronic rhinitis
Nasal polyps
Asthma
Malaise
Rhinorrhea
Bronchospasm
Productive cough
Angioedema
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9
Q

When to Suspect Asthma

A

Persistent cough
Recurrent pneumonia
Responds to albuterol

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10
Q

History is Most Important

A
Recurrent cough
Wheeze
Shortness of breath
Improvement of bronchodilator
Clear triggers
PMH: allergic child
Family Hx: maternal
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11
Q

Physical Exam Findings in Asthma

A
Tripod breathing
Tachypnea
Hypoxemia
Dyspnea
Retractions
Poor aerations
Wheezing
Prolonged I:E ration
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12
Q

Differential Diagnosis of Asthma

A
Allergic rhinitis
Sinusitis
FB
Vascular ring/sling
Laryngo/tracheo/ bronchomalacia
Vocal cord dysfunction
Bronchiololitis
CF
Bronchopulmonary dysplasia
Heart disease
Aspiration/GERD
Asthma
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13
Q

Goals of Treatment of a Pediatric Asthmatic

A

Sleep
Learn
Play

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14
Q

Risk of Exacerbations

A
Severe obstructive disease
2+ ED/hosp in the last year
Patients frightened by exacerbations
Non-white
Women
No ICS
Lower SES
Depression
Stress
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15
Q

Mechanism of ICS in Asthmatics

A

Anti-inflammatory

Reverse beta2 receptor down regulation

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16
Q

Treatment Options of Moderate Persistent Asthma

A

Medium dose ICS
Low dose ICS with LABA
Low dose ICS with LTRA

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17
Q

MOA of Leukotriene Blockers

A

Inhibit inflammation through different pathway

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18
Q

What can Leukotriene Blockers Assist with?

A
Toddlers who wheeze with viruses
Spare steroids
Pill vs. inhaler vs. nebulizer
Not as effective as ICS
May have psych SE
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19
Q

Tools for Asthma Care

A

Handouts
Peak flow meters
Spacers
Spirometry

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20
Q

Treatment of Asthma

A

Asthma Action Plan (AAP)

Symptom or peak flow

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21
Q

Management of Asthma

A

Follow up
Education
Medications
Spirometry annually

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22
Q

Step Up or Step Down Therapy

A

Step up therapy if no response in 4-6 weeks

Step down therapy if good control for 3 months

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23
Q

Instances for Referrals

A

High risk asthma
Atypical signs/symptoms
Comorbid disease
Need for additional resources: psychosocial

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24
Q

Define High Risk Asthma

A

Multiple hospitalizations or ED visits
More than 3 steroid bursts/year
Requiring high dose ICS

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25
Possible Options of Comorbid Disease that Complicate Asthma
Allergies Chronic sinusitis GERD
26
Types of Medication Delivery
``` MDI's Spacers DPI's: dry powder inhalers Nebulizers Pari nebulizers ```
27
MDI Delivery with Spacer
``` Shake vigorously Fully exhale breath/ place spacer in mouth Press down on inhaler Slow, deep breath Hold breath 10 secs Wait between 30-60 seconds btw doses Rinse mouth ```
28
MDI Delivery with Mask Spacer
``` Shake vigorously Fully exhale Place mask over spacer Press down on inhaler Keep mask in place 5-8 breaths Wait 30-60 seconds btw doses Rinse mouth ```
29
DPI Delivery
``` Hold inhaler steadily Actuate inhaler Deep, fast breath Hold breath for 10 seconds Rinse mouth ```
30
Define Asthma Action Plan
Written plan of care from health care provider, includes zones & symptoms
31
What is the Asthma Action Plan for?
Treating Asthma Symptoms
32
What does an Asthma Action Plan Include?
Medication information Usual triggers Special instructions
33
Define Controlled Asthma/Green Zone
No symptoms Active, eating & sleeping well Peak flows at least 80% of best
34
Goal of Green Zone
Participate in all activities & not be limited by asthma
35
Define Yellow Zone
``` Coughing Wheezing Chest tightness SOB Peak flows 50-80% SABA for symptoms ```
36
When does a child in the yellow zone contact their PCP?
12-24 hours | Breathing symptoms increase
37
Define Red Zone
"Quick relief" not effective
38
Symptoms of the Red Zone
``` Bluish lips Pale Difficulty talking, walking, or drinking Retractions in neck, throat, or chest Nasal flaring Obvious distress Altered level of consciousness/confusion ```
39
Acute Management in the ED
3 back to back nebulizer treatment with albuterol & atrovent
40
Respiratory Failure Interventions
``` Increased albuterol dosing SubQ terbutaline SubQ epi IV Magnesium Bipap ```
41
What do you on discharge of an asthma patient?
Education AAP Controller medications Re-label medications for home use
42
Successful Management of Asthma
Routine monitoring of lung function Patient education Environmental factors Pharm
43
Airflow Limitations
Bronchoconstriction Airway hyperresponsiviness Airway edema
44
Symptoms Patterns of Asthma
Perennial vs. seasonal Continual vs. episodic Duration, severity, & frequency Diurnal variations
45
Players in Asthma
Eosinophils Lymphocytes MAST cells Leukotrienes
46
What do leukotrienes do?
Increased vascular permeability/edema Increased mucus production Decreased mucociliary transport Inflammatory cell recruitment
47
Intrinsic Asthma
Non-immune No personal/family hx IgE levels normal Stimuli with no effect in normal subjects can trigger bronchospasm
48
Stimuli in Intrinsic Asthma
``` ASA Pulmonary infections Cold Psychological stress Exercise Inhaled irritants GERD Post nasal drip ```
49
Extrinsic Asthma
Type-1 hypersensitivity reaction Family hx IgE & eosinophil elevated
50
Define Exercise Induced Asthma (EIA)
Exercise or vigorous physical activity triggers acute bronchospasm in persons with heightened airway reactivity
51
Classic Triad of Symptoms for Asthma
Persistent wheeze Chronic episodic dyspnea Chronic cough
52
Associated Symptoms of Asthma
``` Tachypnea Tachycardia Systolic HTN Harsh respirations Prolonged expiration Wheezing Sputum production Chest pain or tightness Hemoptysis Diminished breath sounds Pulses paradoxus ```
53
Diagnostics of Asthma
``` PFT's Provocation testing with methacholine CXR GERD assessment Skin tests Eosinophils & iGE elevations ```
54
Global Strategy for Asthma and Prevention
``` Achieve/maintain control of symptoms Prevent exacerbations Maintain "normal" pulmonary function Maintain normal activity levels Avoid adverse effects from meds Prevent the development of irreversible airflow limitation Prevent mortality ```
55
What is an asthma Action Plan for?
Daily management and for adjusting medications in response to increasing symptoms
56
Management of Asthma
Management of exacerbations Regular follow up Classify severity before treatment
57
4 Classifications of Asthma
Step 1: Intermittent Step 2: Mild persistent Step 3: moderate persistent Step 4: severe persistent
58
Intermittent Asthma
Daytime asthma symptoms
59
Treatment of Intermittent Asthma
SABA for rescue PRN
60
Mild Persistent
More than twice/week 3-4 nocturnal awakenings/month SABA use >2 times/week Minor interference with normal activities
61
Treatment of Mild Persistent
SABA for rescue PRN | Low dose ICS
62
Moderate Persistent
Daily symptoms Nocturnal awakenings >1 times/week Daily SABA use Some limitation in normal activity
63
Treatment of Moderate Persistent
SABA for rescue PRN LABA + low-medium ICS Consider referral to specialist
64
Severe Persistent
Symptoms throughout the day Nightly nocturnal awakenings SABA several times/day Extreme limitation in normal activity
65
Treatment of Severe Persistent
SABA for rescue PRN High dose ICS + LABA Refer to specialist
66
Controlling Asthma Severity
Minimizing exposure to contributing factors
67
Define Status Asthmaticus
Severe bronchospasm that is unresponsive to routine therapy
68
Presentation of Status Asthmaticus
``` Difficulty talking Using accessory muscles of inspiration Orthopnea Diaphoresis Mental status changes ```
69
Treatment of Status Asthmaticus
Oxygen Oximetry ABG's Peak flows with treatments
70
Inadequate Response of Status Asthmaticus
Hospital admission
71
Good Response of Status Asthmaticus
Inhaled B2agonist Inhaled anticholinergic Oral steroids x 5 days Follow up in 5 days