Asthma

Question 1

define asthma

Answer 1

a disease characterized by increased responsiveness of the airways to various stimuli and manifested by widespread narrowing of the airways that changes in severity either spontaneously or as a result of therapy

Question 2

what changes are seen in the airways of a chronic asthmatic

Answer 2

inflammation and edema
mucus and plasma exudation
epithelial shedding and damage

Question 3

list extrinsic asthma triggers

Answer 3

infection
irritants (smoke)
allergen (dust, pollen)
weather change

Question 4

list intrinsic asthma triggers

Answer 4

exercise

stress

Question 5

name 4 patterns of asthma

Answer 5

1. infrequent episodic asthma
2. frequent episodic asthma
3. persistent asthma
4. chronic cough

Question 6

what tests can be used in the dx of asthma

Answer 6

oximetry 
blood--> CBC, blood bases (aminophylline level)
xray
pulmonary function 
allergy testing

Question 7

how do you manage an acute episode of asthma –general

Answer 7

oxygen
fluids
bronchodilators (relax the muscle spasm)
anti inflammatory agents (reduce the airway wall edema and mucous secretion)

Question 8

what inhaled beta agonists can be used in the management of an acute asthma episode

Answer 8

1. salbutamol 5mg and 3 ml saline up to q15min

2. salbutamol by MDI, 6 puffs through spacer q5min

Question 9

what oral steroids can be used in the management of an acute asthma episode

Answer 9

prednisone 1mg/kg q12h

Question 10

what IV steroids can be used in the management of an acute asthma episode

Answer 10

1. methylprednisone 1mg/kg load then 0.5 mg/kg q6h

2. hydrocortisone 4mg/kg/dose q4-6h

Question 11

what IV bronchodilators can be used in the management of an acute asthma episode?

Answer 11

aminophylline 6mg/kg load then 1mg/kg/hr infusion–> monitor levels

Question 12

what factors can be used to gauge how well a childs asthma is controlled

Answer 12

daytime symptoms 
night time symptoms
physical activity
exacerbations
absence from school or work
need for a short acting beta 2 agonist
FEV1 or PEF
PEF diurnal variant

Question 13

what are the aims of chronic asthma therapy

Answer 13

minimize symptoms
allow a normal lifestyle
normalise pulmonary function

Question 14

how do you manage asthma in the long term?

Answer 14

avoid triggers like allergens and smoking

• -no open fires in home
• -animals kept outside

medications

education

Question 15

describe the canadian asthma guidelines asthma treatment continuum

Answer 15

early on, start with just enviro control/education/follow up plus a fast acting bronchodilator on demand

progress to adding inhaled corticosteroids at low/med/high doses

after you start adding a low or mod dose inhaled corticosteroid, consider add on therapy

if patient continues to fail with bronchodilator plus high dose inhaled corticosteroids and add on therapy, consider prednisone

Question 16

why are inhaled medications the most appropriate for astha

Answer 16

local effect

high therapeutic ration

Question 17

what devices would you use to admin asthma drugs in an infant

Answer 17

MDI plus spacer with mask

Wet nebulizer

Question 18

what devices would you use to admin asthma drugs in a toddler

Answer 18

MDI plus spacer with mask for under 3-4 years old

MDI plus spacer with mouthpiece for over 3-4 years old

Question 19

what devices would you use to admin asthma drugs in a child older than 4

Answer 19

MDI plus spacer with mouthpiece

dry powder inhaler device

Question 20

what are the three pieces of info docs should provide to asthma patients and their parents

Answer 20

1. simple explanation of disease and therapy
2. when to alter meds
3. when to seek medical attention

Question 21

what asthma med combats episodic airway constriction?

Answer 21

bronchodilators–> BETA-2 AGONISTS, theophylline, anticholinergics

Question 22

what asthma meds combat the chronic asthma effects of mucous/inflammation/edema etc

Answer 22

antiinflammatories–> CORTICOSTEROIDS, methotrexate etc

Question 23

what changes are seen in the airways of people with asthma

Answer 23

typically affects airways 0.5 - 2 mm range

bronchial muscle hyperplasia

inflammatory cell (eosinophilic) infiltrate

edematous and thickened disrupted epithelium, loss of ciliated cells

luminal obstruction from mucous and cell debris

increased mucous secreting cells in bronchial walls

Question 24

asthma is associated with a family history of what?

Answer 24

atopy

“hyperallergic”

Question 25

what are risk factors for asthma

Answer 25

BPD

bronchiolitis

Question 26

what affects the dose delivered to the lung by a nebulizer?

Answer 26

particle size

minute ventilation

entrainment of air

nasal vs oral inhalation

Question 27

what is the peripheral lunch deposition from a nebulizer in a child and an adult

Answer 27

adult 6%

infant 1-2%

Question 28

symptoms of asthma attacks

Answer 28

dyspnea
chest pain
cough (nocturnal/early morning with or without vomiting)

Question 29

what are the chest signs of an asthma attack

Answer 29

tachypnea
retractions
accessory muscle use
hyperinflation 
wheezing
cyanosis
respiratory failure
subcutaneous emphysema

Question 30

what are the systemic signs of an asthma attack

Answer 30

tachycardia
pulsus paradoxus
anxiety
exhaustion