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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
Q

Goals of quick relief vs long-term control meds for asthma

A

Quick:

  • direct relaxation of bronchial smooth muscle
  • reversal of airflow obstruction

Long-term:
-decrease airway inflammation

26
Q

How do B-2 agonists work?

A

bronchodilator- relive bronchospasm by relaxing bronchial smooth muscle

27
Q

When is a SABA used?

A

work immediately, can by used preventatively or emergently

28
Q

When can a LABA be used? Examples?

A

Used for Prevention!!
not for use as rescue or PRN inhaler

ex:
Formoterol
Salmererol
Arformoterol

29
Q

Black box warning on LABAs?

A

may increase risk of asthma death when used alone (w/o concurrent inhaled steroid)

30
Q

What do inhaled corticosteroids do? When to use? Examples?

A

decrease inflammation

  • not for use as rescue or PRN inhaler
  • Used for Preventative

Ex:
Beclamethasone
Fluticasone
Triamcinolone

31
Q

What is the purpose of combining LABA + ICS? Examples?

A

Long acting relief of bronchospasm + decrease inflammation

prevention only

Ex:
salmeterol + fluticasone
formoterol + budesonide
formoterol + mometasone

32
Q

What do Leukotriene Receptor Antagonists (LTRA) do? When do you use it? Examples

A
  • 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
Q

How do anticholinergics work? When do you use? Examples?

A
  • decrease secretions (mucus)
  • generally used for acute exacerbations only
  • inhaler or nebulization

Ex:
Ipratropium
Tiotropium

34
Q

How do Mast-cell stabilizers work? ex

A

inhibits the release of histamine, leukotrienes, and other mediators from sensitized mast cells

Cromolyn sodium (Intal)

35
Q

How do Monoclonal antibodies work? Ex

A

Recombinant antibody that binds IgE w/o acting mast cells

Omalizumab
Reslizumab

36
Q

How do oral corticosteroids work? When to use? Ex

A
  • Systemic anti-inflammatory effect
  • used for acute exacerbation or severe chronic sx
  • many adverse side effects

Ex: prednisone, methylprednisone

37
Q

If your patient has sx of bronchospasm, what are med options?

A
  • Short-acting beta-agonist

- Long-acting beta-agonist

38
Q

Asthma pt has mucosal edema (inflammation), what are med options?

A
  • inhaled corticosteroids (and oral)
  • leukotriene receptor antagonists
  • (5-Lipoxygenase inhibirto, mast-cell stabilizers, monoclonal antibody)
39
Q

Asthma pt has mucus production, what is med option?

A

Anticholinergics

40
Q

Explain step-therapy

A
  • 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
Q

What medication do ALL asthma pts need to be on?

A

SABA prn!

42
Q

In persistent asthma, what meds are given for steps 2-4?

A

2: low-dose inhaled glucocorticoids

3: low-dose inhaled glucocorticoids + LABA
OR
Medium-dose inhaled glucocorticoids

4: medium-done inhaled glucocorticoids + LABA

43
Q

What are the benefits of monitoring Peak Flow?

A
  • simple, inexpensive
  • helps pt determine need for rescue inhaler
  • peak flow diary helps clinician eval sx control and determine “personal best”
44
Q

What is predicted average PEFR based on?

A

Age and height

45
Q

When so you instruct your pts to use their peak flow meter?

A
  • every morning before taking rx as part of daily routine
  • during asthma sx or attack
  • after taking meds for an attack
46
Q

What do the colors on the peak flow monitor indicate? (green, yellow, red)

A 
green= good
yellow= caution, use SABA
red= go to ER
47
Q

When do you admit pts with asthma exacerbation?

A

pts who do not respond well after 4-6 hrs to ICU

48
Q

Signs/sx of serve exacerbation

A
  • inability to speak full sentences
  • accessory muscle use
  • tripod position
  • inability to lie supine
  • tachycardia
  • tachypnea
  • O2 sat < 90%
49
Q

Signs of imminent respiratory arrest

A
  • confusion
  • cyanosis
  • fatigue
  • agitation
50
Q

How do you tx a pt with mild-moderate exacerbation?

A
  • O2= titrate up > 90%
  • Albuterol + anticholinergic
  • IV or Oral glucocorticoids
51
Q

In addition to tx given for mild-moderate exacerbation, what else can be given to a pt w/ severe exacerbation?

A
  • IV magnesium
  • IV epinephrine
  • Terbutaline
  • Heliox
  • ketamine
  • Neuromuscular blocks
52
Q

What is status asthmatics? Sx?

A
  • 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
Q

Preventative care given to asthma pts?

A

Pneumococcal vaccine

Annual influenza vaccine

54
Q

When do you refer to Pulmonology?

A

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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