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Foundations II Exam 3 (Jess) > Asthma > Flashcards

Asthma Flashcards

1
Q

Asthma is the most common chronic dz in _____?

A

childhood

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2
Q

What are the underlying problems in asthma (4)?

A

airway hyper-responsiveness
inflammation
airflow obstruction
narrowed airway

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3
Q

What kinds of things cause airway hyper-responsiveness?

A
  • particulate inhalants/allergens
  • temp changes
  • stress
  • reflux
  • exercise
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4
Q

Describe the inflammation in asthma (what kinds of cells?)

A

inflammatory cell infiltration w/ eosinophils, neutrophils, and lymphocytes

hyperplasia of goblet (mucus) cells

mast cell activation

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5
Q

What causes airflow obstruction in asthma?

A
  • smooth muscle hypertrophy
  • collagen deposition in basement membrane
  • edema of airways
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6
Q

How is the airway narrowed in asthma? What receptors are involved?

A

Smooth muscle constriction and hyperplasia

Beta-2 receptors and Muscarinic receptors

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7
Q

Classic sx of asthma

are they constant/intermittent and specific/non-specific?

A

Wheezing
cough
dyspnea

Symptoms are intermittent and non-specific

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8
Q

How do you dx Asthma? (what is needed?)

A

History of respiratory sx
AND
demonstration of variable, reversible, expiratory airflow obstruction

AKA
History + Physical + Spirometry (PFTs)

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9
Q

What is the Atopic triad?

A

Allergy + asthma + eczema

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10
Q

What are some non-exacerbation patient clues?

A
  • pale, swollen nasal mucosa= allergic rhinitis
  • nasal polyps
  • ecxema (atopic dermatitis)
  • lung exam: usually nl
  • cardiac: possibly tachy
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11
Q

What is the Gold Standard for diagnosing Asthma?

A

Spirometry / Pulmonary Function Testing (PFTs)

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12
Q

What is FEV1 and FVC?

A

FEV1= forced expiratory volume in 1 sec

FVC= forced vital capacity; amount of air forcefully exhaled after a maximum inhalation

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13
Q

What happens to the FEV1/FVC Ratio in Asthma?

A

decreased!

<70% indicates obstructive dz

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14
Q

After obstruction is identified (FEV1/FVC < 70%), the severity of obstruction is determined. What are the values that indicate mild, moderate, severe obstruction?

A

FEV1 >70% predicted = mild
FEV1 50-69% predicted= moderate
FEV1 <50% predicted= severe

if FVC is below 80% predicted then you have obstruction + low vital capacity

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15
Q

How do you determine reversibility in asthma?

A

pre- and post- bronchodilator measurements

  • 2-3 puffs quick acting bronchodilator (albuterol)
  • wait 15 mins
  • perform spirometry again

FEV1 increase of 12% or more= positive response

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16
Q

Why must you take serial measurements in asthma pt?

A

because asthma is episodic! PFT values may vary depending on pt status!

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17
Q

What are the 4 components that are used to determine severity of asthma?

A
  1. Symptom frequency
  2. Nighttime awakenings
  3. Need for short acting beta-agonist inhaler
  4. Interference w/ normal activity
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18
Q

If you have symptoms in 2 different categories (ex. mild vs moderate), how do you categorize the pt?

A

by the MOST SEVERE symptom/parameter

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19
Q

What is the rule of 2’s?

A

More than 2 of any of the components of severity= persistent

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20
Q

Components of asthma management (4)

A
  1. Routine monitoring of sx and lung function
  2. Patient education to create a clinician and pt partnership
  3. Controlling environmental factors (trigger factors) and comorbid conditions that contribute to asthma severity
  4. Pharmacologic therapy
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21
Q

What are the 2 goals of asthma tx?

A

reduction in impairment and reduction of risk

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22
Q

What is considered reducing impairment?

A
  • freedom from sx
  • minimal need (less than or equal to 2 days per week) of inhaled short acting beta agonists
  • few night-time awakenings (<2 per month)
  • optimization of lung fx
  • maintenance of nl daily activities
  • satisfaction w/ asthma care on the part of pts
23
Q

What is considered reducing risk?

A
  • prevention of recurrent exacerbation and need for ED or hospital care
  • prevention of reduced lung growth in children, and off of lung fx in adults
  • optimization of pharmacotherapy w/ minimal or no adverse effects
24
Q

What are ways you can do environmental control for asthma?

A

controlling triggers and contributing conditions

  • tx allergies
  • avoid respiratory irritants
  • address obesity, GERD
  • control medication triggers
25
Goals of quick relief vs long-term control meds for asthma
Quick: - direct relaxation of bronchial smooth muscle - reversal of airflow obstruction Long-term: -decrease airway inflammation
26
How do B-2 agonists work?
bronchodilator- relive bronchospasm by relaxing bronchial smooth muscle
27
When is a SABA used?
work immediately, can by used preventatively or emergently
28
When can a LABA be used? Examples?
Used for Prevention!! not for use as rescue or PRN inhaler ex: Formoterol Salmererol Arformoterol
29
Black box warning on LABAs?
may increase risk of asthma death when used alone (w/o concurrent inhaled steroid)
30
What do inhaled corticosteroids do? When to use? Examples?
decrease inflammation - not for use as rescue or PRN inhaler - Used for Preventative Ex: Beclamethasone Fluticasone Triamcinolone
31
What is the purpose of combining LABA + ICS? Examples?
Long acting relief of bronchospasm + decrease inflammation prevention only Ex: salmeterol + fluticasone formoterol + budesonide formoterol + mometasone
32
What do Leukotriene Receptor Antagonists (LTRA) do? When do you use it? Examples
- Leukotrienes cause inflammation and mucosal edema - blocking the LT receptor mitigate this effect - oral tables, prevention only - also indicated to tx allergic sx Ex: Montelukast Zafirlukast
33
How do anticholinergics work? When do you use? Examples?
- decrease secretions (mucus) - generally used for acute exacerbations only - inhaler or nebulization Ex: Ipratropium Tiotropium
34
How do Mast-cell stabilizers work? ex
inhibits the release of histamine, leukotrienes, and other mediators from sensitized mast cells Cromolyn sodium (Intal)
35
How do Monoclonal antibodies work? Ex
Recombinant antibody that binds IgE w/o acting mast cells Omalizumab Reslizumab
36
How do oral corticosteroids work? When to use? Ex
- Systemic anti-inflammatory effect - used for acute exacerbation or severe chronic sx - many adverse side effects Ex: prednisone, methylprednisone
37
If your patient has sx of bronchospasm, what are med options?
- Short-acting beta-agonist | - Long-acting beta-agonist
38
Asthma pt has mucosal edema (inflammation), what are med options?
- inhaled corticosteroids (and oral) - leukotriene receptor antagonists - (5-Lipoxygenase inhibirto, mast-cell stabilizers, monoclonal antibody)
39
Asthma pt has mucus production, what is med option?
Anticholinergics
40
Explain step-therapy
- start w/ highest step based on pt's sx, severity categorization and spirometry - re-assess control every few weeks - step up or down as needed - All pts are on SABA prn
41
What medication do ALL asthma pts need to be on?
SABA prn!
42
In persistent asthma, what meds are given for steps 2-4?
2: low-dose inhaled glucocorticoids 3: low-dose inhaled glucocorticoids + LABA OR Medium-dose inhaled glucocorticoids 4: medium-done inhaled glucocorticoids + LABA
43
What are the benefits of monitoring Peak Flow?
- simple, inexpensive - helps pt determine need for rescue inhaler - peak flow diary helps clinician eval sx control and determine "personal best"
44
What is predicted average PEFR based on?
Age and height
45
When so you instruct your pts to use their peak flow meter?
- every morning before taking rx as part of daily routine - during asthma sx or attack - after taking meds for an attack
46
What do the colors on the peak flow monitor indicate? (green, yellow, red)
``` green= good yellow= caution, use SABA red= go to ER ```
47
When do you admit pts with asthma exacerbation?
pts who do not respond well after 4-6 hrs to ICU
48
Signs/sx of serve exacerbation
- inability to speak full sentences - accessory muscle use - tripod position - inability to lie supine - tachycardia - tachypnea - O2 sat < 90%
49
Signs of imminent respiratory arrest
- confusion - cyanosis - fatigue - agitation
50
How do you tx a pt with mild-moderate exacerbation?
- O2= titrate up > 90% - Albuterol + anticholinergic - IV or Oral glucocorticoids
51
In addition to tx given for mild-moderate exacerbation, what else can be given to a pt w/ severe exacerbation?
- IV magnesium - IV epinephrine - Terbutaline - Heliox - ketamine - Neuromuscular blocks
52
What is status asthmatics? Sx?
- acute exacerbation or asthma unresponsive to initial tx w/ bronchodilators - mild-severe form w/ bronchospasm, airway inflammation, and mucus plugging - difficulty breathing, carbon monoxide retention, hyperemia, and respiratory failure
53
Preventative care given to asthma pts?
Pneumococcal vaccine | Annual influenza vaccine
54
When do you refer to Pulmonology?
when sx do not respond to therapy at Step 3 or 4, or if sx are severe

Foundations II Exam 3 (Jess) (6 decks)

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