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Clinical 2.0 winter > Asthma > Flashcards

Asthma Flashcards

1
Q

can you grow out of asthma

A

yes

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2
Q

can you feel fine with asthma

A

yes, do not feel the inflammation in the lungs

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3
Q

use of SABA

A

band aid for the condition
just a reliever/rescue med
shouldnt be filled monthly

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4
Q

what is the mainstay treatment for asthma

A

inhaled corticosteroids

controller/preventor

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5
Q

clinical presentation of asthma

A 
episodic wheezing 
breathlessness
chest tightness
coughing
intervals between symptoms can be days, weeks, onths, years
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6
Q

diagnosis of asthma

A

spirometry demonstrates obstruction
decreased FEV1/FVC
with reversibility following inhaled beta agonist at least a 12% improvement in FEV1 and a difference of 200mL *****

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7
Q

will you feel corticosteroids working

A

never

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8
Q

asthma control criteria

A 
<4days/wk daytime sx
<1nights/wk night sx
normal physical activity 
infrequent exacerbations
no absences
need for a SABA <4doses/wk
FEV/PEF >90% personal best
PEF diurnal variation <15%
sputum eosinophils <3%
no acute care visits
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9
Q

for asthma control the need for a fast acting beta2 agonist is <4doses/wk, does this include exercise

A

yes***

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10
Q

what should you regularly reassess for asthma management

A 
control 
spirometry or PEF 
inhaler technique 
adherence
triggers
comorbidities 
sputum eosinophils
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11
Q

which patients use SABA on demand only

A

very mild

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12
Q

what dose of flovent do you want people on

A

want to maintain on the lowest dose possible 250ug/day

can go on high doses shortly but not for long term chronic control

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13
Q

in adults always add on instead of increasing the dose to get control what do you do in kids

A

increase to a medium dose before adding on another agent

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14
Q

order of the asthma management continuum

A 
SABA on demand
inhaled corticosteroid
LABA
LTRA
anti IgE
prednisone 
long acting muscuranic agonist
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15
Q

when is leukotriene receptor antagonist used

A

second line to inhaled corticosteroid

should only be an add on not a replacement***

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16
Q

should you have to take extra doses to exercise

A

no

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17
Q

what other questions should you ask

A 
feel like getting a cold/flu 
exposure to triggers
limitation in activities 
referred to action plan 
rule out exacerbation
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18
Q

red flags for acute exacerbation

A 
unable to speak 
SOB at rest
reliver not working 
peak flow <60% predicted best 
patient knows from past experience
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19
Q

triggers for asthma attack

A 
resp tract infection 
allergens
environment
food additives
exercise
drihs/preservatives - ASA, NSAIDS, beta blocker
occupational - baker, farmer
emotions
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20
Q

what is recommended once an individual is sensitized to a pet

A

avoidance recommended bc continued exposure is associated with worsening airway inflammation and detioration in asthma control

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21
Q

what is not recommended and recommended for patients with allergic rhinitis or asthma sensitive to house dust mite allergens

A

do not use single chemical or physical preventative methods aimed at reducing exposure to hourse dust mites, try environmental control programs (remove carpet, dust proof pillow and mattress cover)

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22
Q

how do symptoms occur

A

chronic inflammation
airway narrowing caused by contraction of smooth muscle, airway edema, mucus hypersecretion, airway thickening
**remodelling

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23
Q

what is airway remodelling

A

repair in response to chronic inflammation
increases the airway wall thickness - fibrosis, increase smooth muscle, increase mucous glands, increase number of blood vessels

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24
Q

early phase of acute asthma

A

bronchoconstriction within 10 min, mucous hypersecretion, edema
duration : 1 hr

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25
last phase of acute asthma
6-9 hours later continued inflammation, epithelial damage, intensified hyperresponsiveness more severe, prolonged, and difficult to reverse may last for weeks
26
what are the 2 major risk factors for severe exacerbations
underutilization of antiinflammatory drug | excesive reliance on short acting inhaled beta 2 agonists
27
recommended use of ventolin per year
1-2 inhalers per year
28
why are long acting beta agonist inhalers bad in asthma
increase in serious adverse events | not actually treating the problem
29
benefits of inhaled corticosteroids
``` decrease airway hyperresponsiveness decrease inflammation improving pulmonary function decrease asthma symptons, exacerbations, hospitalizations, death improve QOL ```
30
which corticosteroid is best and at what dose
doesnt matter | start low and adjust as needed
31
preferred device for children 0-3yoa
pressured metered dose inhaler plus spacer with face mask
32
preferred device for 4-5yrs
pressurized metered dose inhaler plus spacer with mouthpiece
33
how long for a response with inhaled corticosteroid
decrease symptoms in days to weeks | min improvement 2-4 weeks and max 4-8weeks
34
when should you do a follow up for ICS
1-3 months after starting, if stable every 3-12 months after
35
can you step down on the ICS dose
yes at 3 month intervals
36
can you stop controller treatment
if no sx for 6mon, no risk factors, spirometry, in very mild category could consider choose an appropriate time then a written asthma action plan
37
components of the action plan
outlie recommended daily preventaive management strategies to maintain control when and how to adjust therapy for loss of control provide clear instruction when to seek urgent medical attention
38
the 3 zones of asthma action plan
green- sx free yellow - sx red - danger
39
see the action plan
k
40
can you quadruple advair for step up therapy
FP and salmeterol | no will have too much salmeterol and can cause anxiety etc.
41
can you quadruple symbicort
budenoside/formalderol form is more flexible and can give more good to quadruple up to max 8puffs/day, 6 at a time
42
advantage of ciclesonide
comes as prodrug so not active untill it gets into the lungs so dont get thrush
43
reasons for a lack of response to ICS
``` erroneous diagnosis of asthma comorbidities (GERD, sinusitis, vocal cord dysfunction) poor inhaler device technique poor adherence exposure to environmental triggers ```
44
do ICS stunt growth
no will still reach same height uncontrolled severe asthma also adversely affects growth could measure height yearly in kids on ICS
45
AE for ICS
``` dose dependent thrush dysphonia (change in voice) - switch steroids ```
46
how to prevent thrush
spacer with mouthpiece instead of mask | rinse with water SWISH SWISH SPIT
47
adding LABA instead of increasing dose of ICS benefits
``` decrease rate of exacerbations increase morning and evening PEF decrease time take to achieve wel controlled asthma improve exercise response little evidence for children ```
48
formoterol (LABA) onset of action
1-3 min making it fast acting
49
what is SMART dosing (symbicort maintenance and reliver therapy)
LABA and ICS combo
50
SMART dosing concept
asthma exacerbations evolve over a few days and recent evidence that ICS begins reducing airway inflammation as early as 6 hours by using as needed ICS and formoterol instead of SABA only gives an immediate intervention with on einhaler to control symptoms and prevent exacerbation benefit from timing of higher ICS relative to worsening in sx
51
advantages of SMART dosing
long acting effect of formoterol even at max dose lower corticosteroid exposure overall compared to tradational protocols only one inhaler
52
what does the CTS say about single inhaler therapy
use of bud/form as a reliever and controller at the same ICS dose in patients with asthma uncontrolled on fixed dose ICS/LABA combo instead if increasing ICS dose
53
most common AE of beta2 agonists
``` tremor excitement nervous palpitation tachycardia can also decrease potassium causing heart problems ```
54
what do you use to treat the nose (always first step)
second gen antihistamines or intranasal corticosteroids
55
what is the peak expiratory flow meter
used for self monitoring | to help patient see where they are at
56
when should you recommend a peak expiratory flow meter
poor symptom percievers or severe asthma | can use for 2 weeks when a worsening or change in therapy
57
3 early therapies for exacerbations
repetitive admin of rapid acting inhaled beta2agonist oral systemic glucocorticoids if dont respond in 6hr or histry of severe oxygen supplement
58
reasons not to use prednison long term
causes osteoporosis, diabetes, cataracts
59
what is exercise induced bronchoconstriction
develops 5-10min after completing exercise | resolves spontaneous in 30min
60
how is exercise induced bronchoconstriction diagnosed
rapid improvement after inhaled beta 2 agonist | fall in FEV >15% after 6 min of near max exercise
61
what to do if someone is experiencing exercise induced broncoconstriction
if underlying asthma step up controller therapy in no asthma have spirometry test if need SABA >3x per week need an ICS as well
62
whne should biologics be used
severe allergic client as last resort
63
indication for tiotropium
add on for over 12with severe asthma uncontrolled with ICS/LABA combo
64
recommended inmmunizations
influenza for everyonw | pneumococcal for COPD and other comorbidities

Clinical 2.0 winter (28 decks)

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