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Clinical Medicine II > Asthma > Flashcards

Asthma Flashcards

1
Q

what is the definition of asthma?

A

<b>Chronic, inflammatory disorder of the airways characterized by:</b>

  • Paroxysmal (intermittent) symptoms of cough, wheezing, dyspnea & chest tightness, usually related to specific trigger
  • Airway narrowing that is partially or completely <b>reversible</b>
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2
Q

what is one of the most common chronic diseases of childhood?

A

asthma

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3
Q

who are death rates from asthma highest in?

A

African Americans 15-24 y/o b/c more triggers for asthma in inner city areas and AA’s have unequal access to medical insurance

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4
Q

what are asthma risks?

A

Gender: boys > girls (in childhood)

Socioeconomic status: poverty (esp in urban settings)

Food allergies (associated with intubations for asthma)  fatal asthma
Family history of asthma

<b>***Atopy</b>

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5
Q

what is atopy?

A

A genetic disposition to develop an allergic reaction and produce elevated levels of IgE upon exposure to an environmental antigen and especially one inhaled or ingested

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6
Q

what is the pathophysiology of asthma?

A

airflow obstruction - part from smooth muscle constriction & part from inflammation

<b>-Smooth muscle constriction around airways (can be life threatening)</b>
-Airway wall edema
-Intra-luminal mucus accumulation
<b>-Inflammatory cell infiltration of submucosa & basement membrane thickening</b> (eosinophils, activated helper T cells, mast cells & neutrophils) -> all come to area as part of immune response

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7
Q

what is fatal asthma?

A
  • Severe collagen deposition of basement membrane
  • Desquamation of epithelial lining with loss of ciliated cells lungs don’t clear well & have to get intubated
  • Mucosal edema
  • Airway smooth muscle hyperplasia/hypertrophy adds to luminal narrowing
  • Luminal plugging with inflammatory cells

-Not always fatal

<b>Common in people with food allergies</b>

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8
Q

what are the main physiologic consequences of asthma?

A
  1. Chronic airway inflammation
  2. Reversible or partially reversible bronchoconstriction
  3. Increased airways hyperresponsiveness to a variety of stimuli
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9
Q

what are classic symptoms of asthma?

A

Nonspecific sx’s

  • Intermittent dyspnea
  • Cough (persistent)
  • Wheezing (sudden onset or persistent)
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10
Q

what are additional features of asthma?

A
  • Chest tightness
  • Colds that take >10dys to resolve (URI they can’t get rid of)
  • Apparent triggers (animals, tobacco smoke, perfume)
  • Symptoms awaken patient from sleep
  • Exertional symptoms (i.e. exercise induced asthma)
  • Seasonal (pollen, mold, viruses) -> common triggers
  • Poor school performance & fatigue (sleep deprivation)
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11
Q

what is the cough in asthma like?

A

Usually <b>‘dry hacking’ (non-productive)</b>

  • Nocturnal (Big question to ask patients – need to know if waking up at night b/c classic for asthma)
  • Seasonal
  • Response to specific exposures (cold air, exercise)
  • Lasts >3weeks

<b>Frequently the sole presenting complaint</b>

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12
Q

what are the common triggers of asthma?

A

pollens, viral URIs, exercise

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13
Q

what is something you should always ask an asthma pt when taking history?

A

about previous intubations

-if they have been, means they have <b>fatal asthma</b>

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14
Q

vital signs for asthma

A

usually normal.

Possibly tachypnea, hypoxia if acute flare

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15
Q

general signs of physical exam for asthma

A

typically, no acute distress but respiratory distress if acute flare, <b>can’t speak full sentences without stopping to breath</b>, tripod position, accessory muscle use

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16
Q

lungs on physical exam for asthma

A

widespread, high-pitched, musical <b>wheeze</b> although wheeze is usually absent between exacerbations

Asthma patient who is stable and not having an acute flare lungs will be clear

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17
Q

when is the wheeze of asthma heard?

A

initially with <b>expiration</b> but in severe cases also with inspiration

18
Q

what does critically severe asthma do to the breath sounds?

A

Critically severe asthma causes decreased breath sounds “silent chest/absent breath sounds” (medical emergency)

19
Q

extra-pulmonary physical exam findings associated with asthma?

A
  • Pale, swollen nasal turbinates suggestive of allergic rhinitis
  • Nasal polyps (in adults)
  • Atopic dermatitis (eczema)– risk factor for asthma
20
Q

dx studies for asthma

A

PFTs (spirometry w/bronchodilator response testing or bronchoprovocation challenge - methacholine - elicits asthma)

Peak expiratory flow (done with flow meter)

CXR (to r/o other causes of SOB) - should be normal if nothing else going on

Allergy skin testing to identify triggers

21
Q

what FEV1 & FEV1/FVC ratio be for airway obstruction?

A

FEV1 decreased
-b/c having trouble getting air out d/t bronchoconstriction

<b>FEV1/FVC <0.7 (<70%) – KNOW!!!</b>

22
Q

what does spirometry measure?

A

Measures forced expiratory volume in one second (FEV1)

Measures forced vital capacity (FVC)

23
Q

what is vital capacity?

A

maximum amount of air a person can expel from the lungs after a maximum inhalation

24
Q

if baseline spirometry demonstrates airway obstruction, what do you administer? An increase in the FEV1 of ___ and greater than ___ suggests what?

A

If baseline spirometry demonstrates airway obstruction -> administer albuterol 400mcg by metered-dose inhaler-> repeat spirometry ten minutes after administration.

An increase in the FEV1 of >12% and greater than 0.2 L suggests acute bronchodilator responsiveness
-Means reversible condition aka asthma

25
Q

what does a peak flow meter measure?

A

measures peak expiratory flow

effort dependent

useful for monitoring daily function during txt of acute flare

26
Q

what are the diagnostic essentials for asthma?

A
  • Episodic or chronic symptoms of airflow obstruction
  • Reversibility of airway obstruction, either spontaneously or following bronchodilator therapy
  • Symptoms frequently worse at night or early in the morning
  • Prolonged expiration and diffuse wheezes on physical examination
  • Limitation of airflow on pulmonary function testing or positive Bronchoprovocation challenge
27
Q

what are the most useful components in classifying asthma?

A

symptoms & fréquence of rescue inhaler

28
Q

what is Intermittent asthma for children 5-11 years old according to spirometry?

A

normal FEVE1 b/w exacerbations

FEV1/FVC >.85

29
Q

what is mild persistent asthma for children 5-11 years old according to spirometry?

A

FEV1 normal

FEV1/FVC >.80

30
Q

what is moderate persistent asthma for children 5-11 years old according to spirometry?

A

<b>start to get worsening ratio</b>

FEV1 = 60-80% predicted

FEV1/FVC = 0.75-0.80

31
Q

what is severe persistent asthma for children 5-11 years old according to spirometry?

A

FEV1 <60% predicted

FEV1/FVC

32
Q

what are the components of managing asthma?

A
  • Routine monitoring of symptoms and lung function
  • Patient education
  • Controlling environmental factors (triggers)
  • Pharmacologic therapy
33
Q

what is the management for asthma?

A

start with SABA

-if asthma persists then add on low dose inhaled glucocorticoid & increase from there

34
Q

how do you treat an acute asthma exacerbation?

A

Oxygen (keep O2 >90% but <96% b/c they retain CO2)

Systemic glucocorticoid (Methylprenisolone IV vs prednisone PO)

Short acting bronchodilator (stacked neb)

Magnesium (IV) for severe flares

35
Q

have abx been shown to improve outcomes for asthma?

A

antibiotics have not been shown to improve outcomes unless there is a concomitant infection

vs COPD there is improved outcomes esp if have infection

36
Q

if an adult develops asthma, what is it really most likely?

A

COPD

37
Q

when is asthma diagnosed in children?

A

<7

38
Q

what is common for an adolescent to have in terms of their asthma severity?

A

common to have adolescent remission with possible later recurrence

39
Q

can COPD & asthma co-exist?

A

YES!!!

If patient that has childhood asthma starts smoking cigs, then can develop COPD on top of their asthma

40
Q

what are the co-existing conditions that exacerbate asthma?

A
  • Allergic rhinitis/chronic rhinosinutis
  • Aspirin exacerbated respiratory disease (AERD) (nasal polyps)
  • Aspirin can be a trigger for asthma
  • Gastroesophageal reflux disease (GERD)
  • Cigarette smoking
  • Obesity (associated with increased incidence and severity esp. in women)-Correlated with asthma, but doesn’t cause asthma

Clinical Medicine II (10 decks)

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