Asthma Flashcards
Pathology
Product of bronchoconstriction and inflammation
Obstructive
IgE mast cell mediated
Age-related diagnosis
Generally diagnosed before adulthood (<18)
Between 12-65: Athletic asthma
COPD: generally after 65
Associated symptoms
Wheezing, SOB, cough
AAA
Asthma, Atopy, and Allergies
S&S
Decreased lung sounds and hyperresonance
Diagnosis
PFTs will show FEV1/FVC < 80%
Reversible (beta agonists)
Inducible (with Ach agonists- methylcholine –> will cause bronchoconstriction if + for asthma)
Bronchodilators
SABA
LABA
Anti-inflammatory
Inhaled corticosteroids
Leukotriene antagonists
Oral steroids
Stabilizers
Neatocromyl
Cromolyn
Given when certain that it is athletic asthma
Rarely used
Five categories of asthma
Based on day, night, and FEV1 symptoms
I. Day: <2/wk, Night: <2/mo, FEV1=80%
SABA
II. Day: <1/day, Night: <1/wk, FEV1=80%
SABA + ICS
III. Day: > 1/day, Night: >1/ week, FEV1 = 60-80%
SABA + ICS + LABA (never given alone; always with ICS)
IV: Day: > 1/day, Night Frequent, < 60%
SABA + Increased ICS dose + LABA
V: Refractory
PO steroids
Before putting them on more medication
Make sure that they are:
- Using their inhaler
- Using a spacer (if inhaler is not effective)
- Medication adherence
Asthma Exacerbation- what to do
Give oxygen
Give nebulizer (ipratroprium and albuterol)
Steroids (PO and IV)
Measure PEFR (peak expiratory flow rate)
When you can send them home
No oxygen req
No wheezing
PEFR > 70%
They still need MDI and prednisone
When you need to admit to ICU
Increased oxygen demand
Rising CO2
Decreased lung sounds (wheezing may be going away but that is because they are not able to move air around!!)
They still need ventilator, IV methylprednisolone,, and continuous nebs
When they stay on the floor
They receive nebulizer, IV steroids (starts of scheduled and then gets spaced out)
