Asthma

Question 1

what is asthma classifed by?

Answer 1

airflow obstruction
inflammation
bronchial hyper-responsiveness

Question 2

what are important hx questions to ask a pt with asthma?

Answer 2

how often are you using your inhaler
how many x/week you have sxs
how many nights/week you are woken up by sxs
how has peak flow meter been? 
triggers? 
time exacerbations occur

Question 3

What are some s/s of ashtma?

Answer 3

cough 
expiatory wheezing
chest tightness
SOB 
retractions/accessory muscle use

Question 4

what PE findings may you find in a pt with asthma?

Answer 4

throat: cobble-stoning
pulm: prolonged expiratory wheeze, tachypnea

Question 5

What should be included in the w/u of a pt with asthma?

Answer 5

Peak expiratory flow rate
O2 sat
PFT if new dx

Question 6

what are the rules of two that is a quick way to assess tx effectiveness

Answer 6

Quick-relief inhaler >2x/wk
Awaken at night >2x/mo
Refill quick-relief inhaler >2x/yr

Question 7

what are the tx goals for a pt with asthma?

Answer 7

Symptomatic relief
keep out of hospital
achieve max control w/ few meds

Question 8

How do you manage asthma exacerbations?

Answer 8

O2
SABA [3 tx every 20-30 min, w/ ipratropium if severe]

Systemic corticosteroids in mod-severe exac.

Consider IV MgSO4 or heliox for life-threatening exac.

Question 9

What is the gold standard for dx asthma?

Answer 9

FEV1/FVC: <80% + >12% ↑ of FEV1 w/ bronchodilator therapy

Question 10

Fill in the description for intermittent asthma
Sx: \_\_\_\_\_
Nighttime sxs \_\_\_\_
SABA use: \_\_\_\_
interference with activity \_\_\_\_
lung fxn:\_\_\_\_

Answer 10

Sx: <2 days/wk
Nighttime sx: <2x/mo
SABA use: <2 days/wk
Interference with activity: none
Lung fxn: normal FEV1 bt exacerbations

Question 11

Fill in the description for Mild asthma
Sx: \_\_\_\_\_
Nighttime sxs \_\_\_\_
SABA use: \_\_\_\_
interference with activity \_\_\_\_
lung fxn:\_\_\_\_

Answer 11

Sx: >2day/wk
Nighttime sx: 3-4x/mo
SABA use: >2 days/wk, not daily
Interference with activity: minor limitation
Lung fxn: >80%

Question 12

Fill in the description for moderate asthma
Sx: \_\_\_\_\_
Nighttime sxs \_\_\_\_
SABA use: \_\_\_\_
interference with activity \_\_\_\_
lung fxn:\_\_\_\_

Answer 12

Sx: Daily
Nighttime sx: >1x/wk, not nightly 
SABA use: Daily
Interference with activity: some limitation
Lung fxn: FEV 60%-80% (FEV1/FVC red 5%)

Question 13

Fill in the description for severe asthma
Sx: \_\_\_\_\_
Nighttime sxs \_\_\_\_
SABA use: \_\_\_\_
interference with activity \_\_\_\_
lung fxn:\_\_\_\_

Answer 13

Sx: throughout day 
Nighttime sx: often, 7x/wk
SABA use: several/day 
Interference with activity: extremely limited 
Lung fxn: FEV1 <60% 
FEV1/FVC red >5%

Question 14

What is the step-wise tx for asthma? 
STEP 1: 
STEP 2: 
STEP 3: 
STEP 4: 
STEP 5: 
STEP 6:

Answer 14

STEP 1: SABA PRN

STEP 2: + low dose ICS

STEP 3: low-dose ICS + LABA or Med-dose ICS

STEP 4: Med-dose ICS + LABA

STEP 5: High-dose ICS + LABA

STEP 6: High-dose ICS +LABA + oral corticosteroid

Question 15

What is a SABAs you could use for an asthma pt?

Answer 15

albuterol

Question 16

What is a ICS you could use for an asthma pt?

Answer 16

Beclomethasone

Fluticasone

Question 17

What is a LABA you could use for an asthma pt?

Answer 17

Salmeterol, Formoterol

Question 18

What is an oral steroid you could use for an asthma pt?

Answer 18

Prednisone, methylprednisolone, prednisolone