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BCPS > Asthma > Flashcards

Asthma Flashcards

1
Q

Define Asthma

A

Chronic inflammatory disorder of the airways causing recurrent episodes of wheezing, breathlessness, cough, and chest tightness, particularly at night or early in the morning

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2
Q

What occurs during episodes of asthma

A

Variable airway obstruction, often reversible spontaneously or with treatment
Increased bronchial hyperresponsiveness to stimuli

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3
Q

What are the three Asthma guidelines

A

National Institutes of Health (NIH)
National Heart Lunch and Blood Institute (NHLBI)
National Asthma Education and Prevention Program Guielines (NAEPP)

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4
Q

List the 4 requirements for an Asthma Diagnosis

A
  1. Episodic symptoms of airflow obstruction are present
  2. Airway obstruction is reversible (FEV1 improves by 12% or more after SABA use
  3. COPD is ruled out
  4. Exercise-induced bronchospasms
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5
Q

List 5 differences between Asthma and COPD

A
  1. Cough is nonproductive with asthma and productive with COPD
  2. FEV1 is reversible with asthma but not with COPD
  3. COPD cough is all day, Asthma cough is generally worse at night and early morning
  4. Asthma triggered by allergies/environment, COPD have a common history of smoking
  5. Asthma can be reversed, lung damage from COPD can’t
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6
Q

Exercise-induced bronchospasm presents with what 5 symptoms?

A
  1. cough
  2. SOB
  3. Chest pain or tightness
  4. Wheezing
  5. Endurance problems during exercise
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7
Q

Diagnosis of Exercise-induced bronchospasm requires an exercise challenge in which what must occur?

A

a 15% decrease in FEV1 or peak expiratory flow occurs before and after exercise, measured at 5-minute intervals for 20-30 minutes

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8
Q

What does FEV1 stand for, what does it measure and what are the normal values associated with it?

A

Forced expiratory volume: volume of air exhaled forcefully in the first second of maximal expiration
Normal value is greater than or equal to 50%

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9
Q

In asthma how do you show reversibility with FEV1?

A

if there is an increase of FEV1 greater than or equal to 12% after SABA

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10
Q

What does FVC stand for, how is it measured and what are normal values?

A

measures the maximum volume of air that can be exhaled after full inspiration
Reported in liters and % predicted
Normal adults can empty 80% of air in <6 seconds

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11
Q

what does the FEV1/FVC ratio measure and what are the normal values

A

Differentiates between obstructive and restrictive disease
Normal range within 5% variants is between 75-80% in adults
Decreased in obstructive disease (asthma, COPD) to <70%
Normal/high in restrictive disease (pulmonary fibrosis)

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12
Q

When is FEV1/FVC ratio decreased?

When is it high?

A

Decreased in obstructive disease (asthma, COPD) to <70%

Normal/high in restrictive disease (pulmonary fibrosis)

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13
Q

Name the 4 classifications of Asthma Severity in Adults and Children

A

Intermittent
Mild Persistent
Moderate Persistent
Severe Persistent

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14
Q

How would you classify the severity of asthma for someone experiencing symptoms less than or equal to 2 days per week?

A

Intermittent

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15
Q

How would you classify the severity of asthma for someone experiencing symptoms more than 2 days per week but not daily?

A

Mild Persistent

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16
Q

How would you classify the severity of asthma for someone experiencing symptoms Daily?

A

Moderate Persistent

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17
Q

How would you classify the severity of asthma for someone experiencing symptoms throughout the day?

A

Severe persistent

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18
Q

Nighttime Awakening that occurs 2 or fewer times per month for people aged 5 and up is classified as what severity of asthma?

A

Intermittent

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19
Q

Nighttime Awakening that occurs 3-4 per month for people aged 5 and up is classified as what severity of asthma?

A

Mild Persistent

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20
Q

Nighttime Awakening that occurs more than once weekly but not nightly for people aged 5 and up is classified as what severity of asthma?

A

Moderate Persistent

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21
Q

Nighttime Awakening that occurs nearly every night for people aged 5 and up is classified as what severity of asthma?

A

Severe Persistent

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22
Q

Nighttime awakening that may not occur at all during the month for children aged 0-4 is classified as what severity of asthma?

A

Intermittent

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23
Q

Nighttime awakening that occurs 1-2 times per month for children aged 0-4 is classified as what severity of asthma?

A

Mild Persistent

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24
Q

Nighttime awakening that occurs 3-4 times per month for children aged 0-4 is classified as what severity of asthma?

A

Moderate Persistent

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25
Q

Nighttime awakening that occurs more than once a week for children aged 0-4 is classified as what severity of asthma?

A

Severe Persistent

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26
Q

If a patient uses a SABA for symptom control 2 or fewer days per week, what severity classification do they have?

A

Intermittent

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27
Q

If a patient uses a SABA for symptom control more than 2 days per week but not daily, what severity classification do they have?

A

Mild Persistent

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28
Q

If a patient uses a SABA for symptom control daily, what severity classification do they have?

A

Moderate Persistent

29
Q

If a patient uses a SABA for symptom control several times a day, what severity classification do they have?

A

Severe Persistent

30
Q

What asthma severity classification would somebody with asthma have if they have no interference with normal activity?

A

Intermittent

31
Q

What asthma severity classification would somebody with asthma have if they have minor limitations to their normal activities?

A

Mild Persistent

32
Q

What asthma severity classification would somebody with asthma have if they have some limitations to their normal activities?

A

Moderate Persistent

33
Q

What asthma severity classification would somebody with asthma have if they have extreme limitations to their normal activities?

A

Severe Persistent

34
Q

What would the FEV1/FVC ratio look like for somebody over the age of 12 who has intermittent or mild persistent asthma?

A

Normal

35
Q

What would the FEV1/FVC ratio look like for somebody over the age of 12 who has moderate persistent asthma?

A

reduced by 5%

36
Q

What would the FEV1/FVC ratio look like for somebody over the age of 12 who has severe persistent asthma?

A

Reduced by more than 5%

37
Q

What would the FEV1/FVC ratio look like for somebody aged 5-11 who has intermittent asthma?

A

> 85%

38
Q

What would the FEV1/FVC ratio look like for somebody aged 5-11 who has mild persistent asthma?

A

> 80%

39
Q

What would the FEV1/FVC ratio look like for somebody aged 5-11 who has moderate persistent asthma?

A

75-80%

40
Q

What would the FEV1/FVC ratio look like for somebody aged 5-11 who has severe persistent asthma?

A

<75%

41
Q

What age group is the FEV1/FVC ratio not used to determine asthma severity?

A

0-4 years

42
Q

What % of normal FEV1 would a patient have if they had intermittent or mild persistent asthma?

A

> 80% of normal

43
Q

What % of normal FEV1 would a patient have if they had moderate persistent asthma?

A

60-80%

44
Q

What % of normal FEV1 would a patient have if they had severe persistent asthma?

A

<60%

45
Q

How many asthma exacerbations requiring oral steroids per year would a patient 5 years or older have to be classified as intermittent?

A

0-1

46
Q

How many asthma exacerbations requiring oral steroids per year would a patient 5 years or older have to be classified as mild persistent?

A

2 or more

47
Q

How many asthma exacerbations requiring oral steroids per year would a patient 5 years or older have to be classified as moderate persistent?

A

2 or more

48
Q

How many asthma exacerbations requiring oral steroids per year would a patient 5 years or older have to be classified as severe persistent?

A

2 or more

49
Q

How many asthma exacerbations requiring oral steroids per year would a patient 0-4 years of age have to be classified intermittent?

A

0-1

50
Q

How many asthma exacerbations requiring oral steroids per year would a patient 0-4 years of age have to be classified as anything but intermittent?

A

2 or more in 6 months or 4 or more wheezing episodes per year

51
Q

List the recommended steps for initiating treatment for adults with asthma

A

intermittent use step 1
mild persistent use step 2
moderate persistent use step 3 and consider a short course of oral steroids
severe persistent use step 4 or 5 and consider a short course of oral steroids

52
Q

List the recommended steps for initiating treatment for children aged 5-11 with asthma

A

intermittent use step 1
mild persistent use step 2
moderate persistent use step 3 and consider short course of oral steroids
severe persistent use step 3 or 4 and consider short course of oral steroids

53
Q

List the recommended steps for initiating treatment for children aged 0-4 with asthma

A

intermittent use step 1
mild persistent use step 2
moderate persistent use step 3 and consider short course of oral steroids
severe persistent use step 3 and consider short course of oral steroids

54
Q

List the 6 treatment goals for asthma

A
  1. minimal or no chronic symptoms day or night
  2. minimal or no exacerbations
  3. no limitations on activities; no school/work missed
  4. maintain near-normal pulmonary function
  5. minimal use of SABAs
  6. minimal or no adverse effects from medications
55
Q

list the treatments a patient receiving step 1 therapy would receive at each age group

A

no long-term control needed

use SABA prn for quick relief for all ages.

56
Q

How many doses per week (excluding pre-exercise doses) of SABAs would be considered inadequate control requiring step-up treatment?

A

> 2 per week

57
Q

list the treatments a patient receiving step 2 therapy would receive at each age group

A

ages 5 and up would receive low-dose inhaled corticosteroids
- may receive LTM, theophylline, or cromolyn as alternatives.
for ages 0-4 low-dose ICS or montelukast/cromolyn as alternates.
all ages receive SABA prn for quick relief

58
Q

List the treatments a patient over the age of 12 on step 3 therapy for asthma would receive

A

preferred: low-dose ICS plus LABA -or- medium-dose ICS alone
Alternative: low-dose ICS plus LTM or theophylline

59
Q

List the treatments a patient ages 5-11 would receive if receiving step 3 asthma therapy

A

preferred: low-dose ICS plus LABA, LTM or theophylline -or- medium-dose ICS alone
SABA prn for quick relief

60
Q

List the treatments a patient ages 0-4 would receive if receiving step 3 asthma therapy

A

medium-dose ICS with SABA prn

61
Q

List the treatments a patient ages 5 and up would receive if receiving step 4 asthma therapy

A

Preferred: medium-dose ICS plus LABA
Alternative: mediu,-dose ICS plus LTM or theophylline
SABA prn

62
Q

List the treatments a patient ages 0-4 would receive if receiving step 4 asthma therapy

A

Preferred: medium-dose ICS plus LABA or montelukast
Alternative: medium-dose ICS plus other LTM or theophylline

63
Q

List the treatments a patient ages 12 and up would receive if receiving step 5 asthma therapy

A

high-dose ICS plus LABA and consider omalizumab for allergic asthma
SABA prn

64
Q

List the treatments a patient ages 5-11 would receive if receiving step 5 asthma therapy

A

preferred: high-dose ICS plus LABA
alternative: high-dose ICS plus LTM or theophylline
SABA prn

65
Q

List the treatments a patient ages 0-4 would receive if receiving step 5 asthma therapy

A

high-dose ICS plus LABA or montelukast

SABA prn

66
Q

List the treatments a patient ages 12 and up would receive if receiving step 6 asthma therapy

A

high-dose ICS plus LABA plus systemic corticosteroids and consider omalizumab for allergic asthma
SABA prn

67
Q

List the treatments a patient ages 5-11 would receive if receiving step 6 asthma therapy

A

preferred: high-dose ICS plus LABA plus systemic corticosteroids
alternative: high-dose ICS plus LTM or theophylline plus systemic corticosteroids
SABA prn

68
Q

List the treatments a patient ages 0-4 would receive if receiving step 6 asthma therapy

A

high-dose ICS plus LABA or montelukast plus systemic corticosteroids
SABA prn

BCPS (1 decks)

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