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foundations pulm exam > asthma > Flashcards

asthma Flashcards

1
Q

define asthma

A 
chronic disorder
variable and recurring symptoms
airflow obstruction
bronchial hyperresponsiveness
underlying inflammation
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2
Q

what are examples of airway hyper-responsiveness?

A 
particulate inhalants/allergens
temperature changes
stress
reflux
exercise
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3
Q

what are examples of inflammation?

A

inflammatory cell infiltration with eosinophils, neutrophils and T lymphocytes
hyperplasia of goblet cells
mast cell activation

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4
Q

what are examples of airflow obstruction?

A

smooth muscle hypertrophy
collagen deposition in basement membranes
edema of airways

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5
Q

what are examples of narrowed airway?

A

smooth muscle constriction and hyperplasia

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6
Q

what are the main two receptors in asthma?

A

beta-2 receptors and muscarinic receptors for smooth muscle relaxation

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7
Q

what are the classic symptoms of asthma?

A

wheezing, cough, and dyspnea

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8
Q

how do you diagnose asthma?

A

hx of respiratory symptoms AND demonstration of variable, reversible, expiratory airflow obstruction as well has H&P AND spirometry

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9
Q

what in the pt’s hx could lead to increased risk for asthma?

A

atopy, obesity, allergies, smoking, atopy in family hx, respiratory disease

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10
Q

what might you see in the ROS for asthma?

A

general: fever, chills, night sweats, weight loss
skin: eczema, rashes, pruritis
HEENT: itchy eyes, nasal congestion, sneezing
Pulm: wheezing, cough, dyspnea
Cardiac: chest pain, palpitations, edema, orthopnea

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11
Q

what is the atopic triad?

A

allergy, asthma, and eczema

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12
Q

what are non-exacerbation pt clues?

A 
allergic rhinitis
nasal polyps
eczema
normal lung exam
possible tachycardia
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13
Q

what is the gold standard for diagnosing asthma?

A

spirometry

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14
Q

what are normal FEV1 and FVC values?

A

80% or greater

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15
Q

what FEV1/FVC ratio indicates obstructive disease?

A

less than 70%

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16
Q

FEV1 tells us how ______ the obstruction is

A

severe

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17
Q

how to classify the obstructions?

A

over 70 = mild
50-69 = moderate
under 50 = severe

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18
Q

in spirometry, we look at _______

A

reversibility

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19
Q

FEV1 needs to increase by how much to indicate a positive response?

A

12% or more

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20
Q

in a bronchoprovocation test, what does the pt inhale to determine if he/she has a hyperresponsive response?

A

metacholine

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21
Q

what are the four categories of symptoms that therapy is based on?

A
  1. symptom frequency
  2. nighttime awakenings
  3. need for SABA inhaler
  4. interference with normal activity

choose the most severe symptom

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22
Q

intermittent asthma is classified how?

A

having symptom frequency 2 days or less per week
having nighttime awakenings 2 or less times per month
SABA use 2 days or less per week
no interference with normal activity
0-1 systemic steroid use per year

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23
Q

mild persistent asthma is classified how?

A 
symptom frequency >2 days/week
nighttime awakenings 3-4x/month
SABA use > 2 days/week
minor limitation with normal activity
2 or more systemic steroid use per year
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24
Q

moderate persistent asthma is classified how?

A 
symptom frequency daily
nighttime awakenings more than once per week but not nightly
SABA use daily
some limitation with normal activity
2 or more systemic steroid use per year
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25
Q

severe persistent asthma is classified how?

A 
symptom frequency throughout the day
nighttime awakenings often 7x/week
SABA use several times per day
extremely limited with normal activity
2 or more systemic steroid use per year
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26
Q

what are the four essential components in managing asthma?

A
  1. routine monitoring of symptoms and lung function
  2. patient education
  3. environmental factors (trigger factors) and comorbid conditions that contribute to asthma severity
  4. pharmacologic therapy
27
Q

the first goal of reducing impairment in asthma is?

A

keeping the symptoms under 2 times per week or month

28
Q

what are possible medications that can trigger asthma?

A

ASA and NSAIDS

29
Q

what are dietary sulfides to avoid?

A 
beer
wine
processed potatoes
dried fruit
sauerkraut
shrimp
30
Q

in airflow obstruction, smooth muscle constriction could lead to?

A

bronchospasm

31
Q

what does a B-2 agonist do?

A

bronchodilator - relieves bronchospasm by relaxing bronchial smooth muscle

32
Q

what are the two types of B-2 agonists?

A

SABA and LABA

33
Q

which B-2 agonist can you use in exercise induced asthma?

A

SABA

34
Q

what are examples of SABAs?

A

albuterol
pirbuterol
levalbuterol (use this if pt has tachycardia or palpitations with albuterol)

35
Q

LABAs are NOT for ________

A

emergencies

36
Q

what are examples of LABAs?

A

formoterol
salmeterol
arformoterol

37
Q

what is the black box warning for LABA

A

increase the risk fo asthma death when used alone without concurrent inhaled steroid (increased risk in black population)

38
Q

inhaled corticosteroids are used in conjunction with LABAs, what are examples of inhaled corticosteroids?

A

beclamethasone
fluticasone
triamcinolone

39
Q

what are examples of LABA and ICS combination inhalers?

A

salmeterol + fluticasone
formoterol + budesonide
formoterol + mometasone

40
Q

leukotriene receptor antagonist (LTRA) is not a first line asthma/allergy medication, what are examples?

A

montelukast (singulair)

zafirlukast

41
Q

what med class is only used for acute exacerbations?

A 
anticholinergics
examples:
ipratropium
tiotropium
*can be combined with SABA
42
Q

if someone has very severe asthma, what medication would you use?

A

monoclonal antibody
examples:
omalizumab
reslizumab and mepolizumab (use in eosinophilia)

43
Q

when are oral corticosteroids used?

A

acute exacerbations or severe chronic symptoms

examples: prednisone or methylprednisolone

44
Q

what meds are used for mucus production?

A

anticholinergics

45
Q

what meds are used for bronchospasm?

A

SABA and LABA

46
Q

what meds are used for mucosal edema (inflammation)?

A

inhaled corticosteroids
LTRA
5-lipoxygenase inhibitor, mast-cell stabilizers, monoclonal antibody

47
Q

what med do you give if intermittent asthma?

A

SABA PRN

48
Q

how do you treat persistent asthma with medications?

A

up the dose of the ICS (low, medium, high) + LABA

49
Q

if high dose ICS and LABA are not working, what do you add?

A

oral systemic glucocorticoids

also be considering omalizumab in pts with allergies

50
Q

what is the peak flow expiratory rate (PEFR)

A

helps pt determine need for rescue inhaler

predicted average PEFR based on age/height

51
Q

PEFR has a color scale of green, yellow, and red, what does each color mean?

A 
green = good to go
yellow = caution, use SABA
red = go to ER
52
Q

what medication should you consider adding to a SABA for severe exacerbations?

A

ipratropium

53
Q

if no immediate and marked response to the SABA, what should you start?

A

IV steroids

54
Q

when should you consider admitting pts to the ICU if not responding to treatment?

A

4-6 hours

55
Q

what are S&S of acute exacerbations?

A 
inability to speak full sentences
accessory muscle use
tri-pod positioning
inability to lie supine
SpO2 < 90%
PCO2 elevated
56
Q

what are imminent respiratory arrest signs?

A

confusion
cyanosis
fatigue
agitation

57
Q

how to treat mild-moderate exacerbations in hospital?

A

titrate O2 until SpO2 > 90%
albuterol + anticholinergic
IV or oral glucocorticosteroids (4-6 hr to work)

58
Q

what are adjunct therapies for severe exacerbation?

A 
IV magnesium
IV epinephrine
terbutaline
heliox
ketamine
neuromuscular blockers
59
Q

if pt does well with 2-3 treatments of SABA (20 minutes apart) at the office, what is the next step?

A

continue SABA q3-4h for the next 24-48 hours

can consider short course of oral systemic corticosteroids

60
Q

if pt has incomplete response to the 2-3 treatments of SABA, what is the next step?

A

add oral systemic corticosteroid
continue SABA
contact clinician

61
Q

if pt has no response to the 2-3 treatments of SABA, what is the next step?

A

call your doctor and proceed to the ED

62
Q

define status asthmaticus

A

acute exacerbation of asthma unresponsive to initial treatment with bronchodilators
symptoms of dyspnea, CO2 retention, hypoxemia and respiratory failure

63
Q

what are preventative measures for asthma?

A

pneumococcal vaccination

annual influenza vaccination

foundations pulm exam (10 decks)

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