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Pulmonology > Asthma > Flashcards

Asthma Flashcards

1
Q

Where?

A

Conducting airways

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2
Q

Bronchoconstriction

From?

A
  • vagal innervation (para)
  • Ach, Methacholine
  • histamine
  • decrease in PACO2
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3
Q

Bronchodilation

From?
Difference night vs. day?

A

B2 adrenergic receptors, circulating catecholamines

Less catecholamines at night, so worse s/s

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4
Q

Obstructive Ventilatory Defect

Which diseases?

A
  • Asthma,
  • chronic obstructive bronchitis,
  • bronchiectasis,
  • emphysema
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5
Q

Up turbulence = _______ pressure needed?

A

More

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6
Q

MMEFR (FEF25-75)

Use?

A

Smaller airway dz

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

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7
Q

PEFR (FEFmax)

Name?
Use?

A

Peak expiratory flow rate

Highest expiratory flow achieved

Good for home monitoring

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8
Q

Normal FEV/VC

A

80%

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9
Q

Obstructive FEV/VC

A

40%, total amount of both down

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10
Q

Types of airway obstruction in asthma

A

Secretions
Wall inflammation
Bronchoconstriction

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11
Q

Lower FEV1/FVC % =

A

Obstruction

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12
Q

Type of expression in asthma cell

A

Th2

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13
Q

Chronic _______ bronchitis

A

Eosinophilic

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14
Q

Low V/Q mismatch –>

A

Low V/Q units –> localized alveolar hypoxia

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15
Q

Induce bronchoconstriction

What?
Why?

A

Methylcholine

Resembles Ach

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16
Q

How to show hyperresponsiveness?

A

Earliness of Fall of FEV1 w/ methacholine

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17
Q

s/s of asthma

A
  • cough
  • wheezing
  • dyspnea
  • chest tightness
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18
Q

Asthma s/s with no respiratory inflammation?

A

Obesity

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19
Q
  • childhood onset
  • FH = atopy
  • preceeded by allergic rhinitis, urticaria, eczema
  • triggered by environment
  • prick test
A

Allergic (atopic) asthma

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20
Q

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

A

Respiratory virus asthma

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21
Q

Exercise-induced asthma

Mech?

A

From amount of heat energy needed to humidify + warm air

22
Q

Comorbid conditions that can trigger

A

Sinusitis
GERD
Obstructive Sleep Apnea
ABPA

23
Q

Asthma evaluation

A
  • ID triggers
  • ID comorbid conditions
  • Med treatment hx
  • severity
24
Q

Asthma Dx

A

Spirometry b/f and after spirometry w/ bronchodilator

If normal but suspect = methacholine challenge

25
Q

Long term goals Tx

A
  • Symptom control
  • Risk reduction

NEED GOOD RELATIONSHIP w/ Patient

26
Q

control =

A
  • s/s
  • airway obstruction
  • effect on life

SYMPTOM + FUTURE RISK

27
Q

Severity categories

A

Mild
Moderate
Severe

28
Q

Severity

Impairment =

A

Patients recall of symptoms

Activity levels

Lung function

29
Q

Control

key s/s

A
  • Daytime s/s
  • nocturnal wakening
  • frequency of SABA use
  • inability to perform activity
30
Q

Asthma control

A
  • 4 key s/s
  • monitoring pulmonary function
  • monitoring history of AE/asthma
  • monitor pharmacology (compliance/technique)
  • adjust therapy as needed
31
Q

Rescue inhalor use in controlled asthma

A

2x per week

Inhalor lasts 50 weeks

32
Q

When should see follow-up to reassess?

A

Every 3 months

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

33
Q

Asthma
Nasal Polyps
ASA/NSAID allergy

A

Samter’s Triad = atopic dermatitis

34
Q

Path
Airway hyperreactivity

Cell type? 2 types?

A

Early IgE –> T cell

  • Extrinsic - allergic triggers
  • Intrinsic - non-allergic triggers (infection/URI, Rx, occupation, cold)
35
Q

Path
Bronchoconstriction

physics? result?

A

airway narrowing, up resistance, down EXPIRATORY flow

result : airway remodeling

36
Q

Path
Inflammation

Why?

A

cellular infiltration (T lymph, neutro, eosino = leukotrienes)

UP histamine (igE)

37
Q

S/s

classic triad

A

dyspnea
wheezing
cough
=/- chest tightness

38
Q
  • inability to complete sentence
  • altered mental
  • pulsus paradoxicus (inspiratory DOWN SBP>10)
  • cyanosis
  • tripod
  • silent chest
  • tac = cardio pulm
A

Severe asthma

Status asthmaticus

39
Q

SABAs

A

Albuterol
Levalbuterol
Terbutaline
Epi

40
Q

Antichol short term

A

ipatroprium

41
Q

Corticosteroids long term

A

Beclomethasone,
Flunisolide,
Triamcinolone

1st line - long term

42
Q

LABAs

A

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

43
Q

Mast cell modifiers

A

Cromolyn

Nedocromil

44
Q

Leukotriene inhibitors

A

Monteleukast
Zafirlukast
Zileuton
Theophylline

Asthmatics w/ aspirin induced/allergic rhinitis

45
Q
  • less than 2 attacks per day/week

* Normal FEV1

A

intermittent

Inhaled SABA as needed

46
Q
  • 2+ days a week, but NOT daily or +1 in a day (same SABA)
  • FEV1 > 80%
  • FEV1/FVC normal
  • 3-4 night awakenings/month
A

Mild

Inhaled SABA
Low dose ICS

47
Q
  • Daily s/s ~ SABA daily
  • > 1 night awakening / week (not daily)
  • FEV1 = 60-80%
  • FEV1/FVC = DOWN 5%
A

Moderate

*Low ICS + LABA
OR
*UP ICS dose
OR
*+ LTRA
48
Q
  • s/s throughout day
  • SABA several times a day
  • night awakening usually every night
  • FEV1= <60%
  • FEV1/FVC= DOWN 5%
A

Severe

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

49
Q

GINA Stepwise treatment

A

*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

50
Q

Asthma Interview

A
  • S/S + pattern
  • Triggers
  • Dz developtment/treatment
  • FH
  • Social (home//tobacco/occupation)
  • Exacerbation profile
  • impact on patient/family
  • Patient’s perception of dz
51
Q

Essential to Dx?

A

Spirometry

Show AWO

52
Q

Anti IgE Rx

A

Omalizumab

*severe, uncontrolled

Pulmonology (12 decks)

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