cough wheezing dyspnea chest tightness

Asthma Flashcards by O lawformonde

Where?

Conducting airways

How well did you know this?

Not at all

Perfectly

Bronchoconstriction

From?

vagal innervation (para)
Ach, Methacholine
histamine
decrease in PACO2

How well did you know this?

Not at all

Perfectly

Bronchodilation

From?
Difference night vs. day?

B2 adrenergic receptors, circulating catecholamines

Less catecholamines at night, so worse s/s

How well did you know this?

Not at all

Perfectly

Obstructive Ventilatory Defect

Which diseases?

Asthma,
chronic obstructive bronchitis,
bronchiectasis,
emphysema

How well did you know this?

Not at all

Perfectly

Up turbulence = _______ pressure needed?

How well did you know this?

Not at all

Perfectly

MMEFR (FEF25-75)

Use?

Smaller airway dz

Maximum mid-expiratory flow rate
Forced expiratory flow over the middle half of FVC

How well did you know this?

Not at all

Perfectly

PEFR (FEFmax)

Name?
Use?

Peak expiratory flow rate

Highest expiratory flow achieved

Good for home monitoring

How well did you know this?

Not at all

Perfectly

Normal FEV/VC

80%

How well did you know this?

Not at all

Perfectly

Obstructive FEV/VC

40%, total amount of both down

How well did you know this?

Not at all

Perfectly

Types of airway obstruction in asthma

Secretions
Wall inflammation
Bronchoconstriction

How well did you know this?

Not at all

Perfectly

Lower FEV1/FVC % =

Obstruction

How well did you know this?

Not at all

Perfectly

Type of expression in asthma cell

Th2

How well did you know this?

Not at all

Perfectly

Chronic _______ bronchitis

Eosinophilic

How well did you know this?

Not at all

Perfectly

Low V/Q mismatch –>

Low V/Q units –> localized alveolar hypoxia

How well did you know this?

Not at all

Perfectly

Induce bronchoconstriction

What?
Why?

Methylcholine

Resembles Ach

How well did you know this?

Not at all

Perfectly

How to show hyperresponsiveness?

Earliness of Fall of FEV1 w/ methacholine

How well did you know this?

Not at all

Perfectly

s/s of asthma

cough
wheezing
dyspnea
chest tightness

How well did you know this?

Not at all

Perfectly

Asthma s/s with no respiratory inflammation?

Obesity

How well did you know this?

Not at all

Perfectly

childhood onset
FH = atopy
preceeded by allergic rhinitis, urticaria, eczema
triggered by environment
prick test

Allergic (atopic) asthma

How well did you know this?

Not at all

Perfectly

*up to 4 weeks
*AWHR up
*w/ RSV, Rhinovirus
*NEUTROPHIL RESPONSE 1st, then eosinophil
*

Respiratory virus asthma

How well did you know this?

Not at all

Perfectly

Exercise-induced asthma

Mech?

From amount of heat energy needed to humidify + warm air

Comorbid conditions that can trigger

Sinusitis
GERD
Obstructive Sleep Apnea
ABPA

Asthma evaluation

ID triggers
ID comorbid conditions
Med treatment hx
severity

Asthma Dx

Spirometry b/f and after spirometry w/ bronchodilator

If normal but suspect = methacholine challenge

Long term goals Tx

* Symptom control * Risk reduction NEED GOOD RELATIONSHIP w/ Patient

control =

* s/s * airway obstruction * effect on life SYMPTOM + FUTURE RISK

Severity categories

Mild Moderate Severe

Severity Impairment =

Patients recall of symptoms Activity levels Lung function

Control key s/s

* Daytime s/s * nocturnal wakening * frequency of SABA use * inability to perform activity

Asthma control

* 4 key s/s * monitoring pulmonary function * monitoring history of AE/asthma * monitor pharmacology (compliance/technique) * adjust therapy as needed

Rescue inhalor use in controlled asthma

2x per week | Inhalor lasts 50 weeks

When should see follow-up to reassess?

Every 3 months If stepped up : (sustained) 2-3 months (Short term) 1-2 weeks

Asthma Nasal Polyps ASA/NSAID allergy

Samter's Triad = atopic dermatitis

Path Airway hyperreactivity Cell type? 2 types?

Early IgE --> T cell * Extrinsic - allergic triggers * Intrinsic - non-allergic triggers (infection/URI, Rx, occupation, cold)

Path Bronchoconstriction physics? result?

airway narrowing, up resistance, down EXPIRATORY flow result : airway remodeling

Path Inflammation Why?

cellular infiltration (T lymph, neutro, eosino = leukotrienes) UP histamine (igE)

S/s classic triad

dyspnea wheezing cough =/- chest tightness

* inability to complete sentence * altered mental * pulsus paradoxicus (inspiratory DOWN SBP>10) * cyanosis * tripod * silent chest * tac = cardio pulm

Severe asthma | Status asthmaticus

SABAs

Albuterol Levalbuterol Terbutaline Epi

Antichol short term

ipatroprium

Corticosteroids long term

Beclomethasone, Flunisolide, Triamcinolone 1st line - long term

LABAs

Salmeterol Symbicort (Budesonide/Formoterol) Advair (fluticasone/Salmeterol)

Mast cell modifiers

Cromolyn | Nedocromil

Leukotriene inhibitors

Monteleukast Zafirlukast Zileuton Theophylline Asthmatics w/ aspirin induced/allergic rhinitis

* less than 2 attacks per day/week | * Normal FEV1

intermittent Inhaled SABA as needed

* 2+ days a week, but NOT daily or +1 in a day (same SABA) * FEV1 > 80% * FEV1/FVC normal * 3-4 night awakenings/month

Mild Inhaled SABA Low dose ICS

* Daily s/s ~ SABA daily * >1 night awakening / week (not daily) * FEV1 = 60-80% * FEV1/FVC = DOWN 5%

Moderate ``` *Low ICS + LABA OR *UP ICS dose OR *+ LTRA ```

* s/s throughout day * SABA several times a day * night awakening usually every night * FEV1= <60% * FEV1/FVC= DOWN 5%

Severe High dose ICS + LABA +/- Omalizumab (anti - IgE)

GINA Stepwise treatment

*Step 2= low dose ICS OR LTRA/Low theophylline *Step 3=Low dose ICS/LABA Step 4= Med/high ICS/LABA Setp 5= Add-on Tx (tiotropium, anti-IgE, Anti-IL5

Asthma Interview

* S/S + pattern * Triggers * Dz developtment/treatment * FH * Social (home//tobacco/occupation) * Exacerbation profile * impact on patient/family * Patient's perception of dz

Essential to Dx?

Spirometry | Show AWO

Anti IgE Rx

Omalizumab *severe, uncontrolled