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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
Q

last phase of acute asthma

A

6-9 hours later
continued inflammation, epithelial damage, intensified hyperresponsiveness
more severe, prolonged, and difficult to reverse
may last for weeks

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26
Q

what are the 2 major risk factors for severe exacerbations

A

underutilization of antiinflammatory drug

excesive reliance on short acting inhaled beta 2 agonists

27
Q

recommended use of ventolin per year

A

1-2 inhalers per year

28
Q

why are long acting beta agonist inhalers bad in asthma

A

increase in serious adverse events

not actually treating the problem

29
Q

benefits of inhaled corticosteroids

A 
decrease airway hyperresponsiveness
decrease inflammation 
improving pulmonary function 
decrease asthma symptons, exacerbations, hospitalizations, death
improve QOL
30
Q

which corticosteroid is best and at what dose

A

doesnt matter

start low and adjust as needed

31
Q

preferred device for children 0-3yoa

A

pressured metered dose inhaler plus spacer with face mask

32
Q

preferred device for 4-5yrs

A

pressurized metered dose inhaler plus spacer with mouthpiece

33
Q

how long for a response with inhaled corticosteroid

A

decrease symptoms in days to weeks

min improvement 2-4 weeks and max 4-8weeks

34
Q

when should you do a follow up for ICS

A

1-3 months after starting, if stable every 3-12 months after

35
Q

can you step down on the ICS dose

A

yes at 3 month intervals

36
Q

can you stop controller treatment

A

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
Q

components of the action plan

A

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
Q

the 3 zones of asthma action plan

A

green- sx free
yellow - sx
red - danger

39
Q

see the action plan

A

k

40
Q

can you quadruple advair for step up therapy

A

FP and salmeterol

no will have too much salmeterol and can cause anxiety etc.

41
Q

can you quadruple symbicort

A

budenoside/formalderol
form is more flexible and can give more
good to quadruple up to max 8puffs/day, 6 at a time

42
Q

advantage of ciclesonide

A

comes as prodrug so not active untill it gets into the lungs so dont get thrush

43
Q

reasons for a lack of response to ICS

A 
erroneous diagnosis of asthma 
comorbidities (GERD, sinusitis, vocal cord dysfunction)
poor inhaler device technique
poor adherence
exposure to environmental triggers
44
Q

do ICS stunt growth

A

no will still reach same height
uncontrolled severe asthma also adversely affects growth
could measure height yearly in kids on ICS

45
Q

AE for ICS

A 
dose dependent 
thrush
dysphonia (change in voice) - switch steroids
46
Q

how to prevent thrush

A

spacer with mouthpiece instead of mask

rinse with water SWISH SWISH SPIT

47
Q

adding LABA instead of increasing dose of ICS benefits

A 
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
Q

formoterol (LABA) onset of action

A

1-3 min making it fast acting

49
Q

what is SMART dosing (symbicort maintenance and reliver therapy)

A

LABA and ICS combo

50
Q

SMART dosing concept

A

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
Q

advantages of SMART dosing

A

long acting effect of formoterol
even at max dose lower corticosteroid exposure overall compared to tradational protocols
only one inhaler

52
Q

what does the CTS say about single inhaler therapy

A

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
Q

most common AE of beta2 agonists

A 
tremor
excitement
nervous
palpitation
tachycardia 
can also decrease potassium causing heart problems
54
Q

what do you use to treat the nose (always first step)

A

second gen antihistamines or intranasal corticosteroids

55
Q

what is the peak expiratory flow meter

A

used for self monitoring

to help patient see where they are at

56
Q

when should you recommend a peak expiratory flow meter

A

poor symptom percievers or severe asthma

can use for 2 weeks when a worsening or change in therapy

57
Q

3 early therapies for exacerbations

A

repetitive admin of rapid acting inhaled beta2agonist
oral systemic glucocorticoids if dont respond in 6hr or histry of severe
oxygen supplement

58
Q

reasons not to use prednison long term

A

causes osteoporosis, diabetes, cataracts

59
Q

what is exercise induced bronchoconstriction

A

develops 5-10min after completing exercise

resolves spontaneous in 30min

60
Q

how is exercise induced bronchoconstriction diagnosed

A

rapid improvement after inhaled beta 2 agonist

fall in FEV >15% after 6 min of near max exercise

61
Q

what to do if someone is experiencing exercise induced broncoconstriction

A

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
Q

whne should biologics be used

A

severe allergic client as last resort

63
Q

indication for tiotropium

A

add on for over 12with severe asthma uncontrolled with ICS/LABA combo

64
Q

recommended inmmunizations

A

influenza for everyonw

pneumococcal for COPD and other comorbidities

Clinical 2.0 winter (28 decks)

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