Asthma Flashcards
What is the most common chronic dz in childhood?
Asthma
Asthma sx’s
- Wheezing (expiratory)
- Cough (nocturnal)
- Dyspnea
* Non-specific
Asthma Dx
- Hx of respiratory sx’s AND
- Demonstration of variable, reversible*, expiratory airflow obstruction
- History + Physical AND spirometry
What is one of the biggest risks factors for having asthma?
Atopy
- Genetic association
- Predisposition toward developing certain allergic hypersensitivity rxn
- -> i.e. atopic dermatitis
Atopic triad
- Allergy- Allergic rhinitis, nasal polyps (ASA allergy??)
- Asthma
- Eczema- Atopic dermatitis
What is the gold standard diagnostic test?
Spirometry/PFTs
What does FEV1 tell you?
Forced expiratory volume in 1 sec
Tells you the Severity of obstruction
What is a normal FEV1 value?
> or equal to 80%
What is a normal FVC value?
> or equal to 80%
What FEV1/FVC ratio percentage indicates obstructive disease?
<70%
What FEV1 value is considered mild obstruction?
> 70%
What FEV1 value is considered moderate obstruction?
50-69&
What FEV1 value is considered severe obstruction?
<50%
What determines reversibility?
Bronchodilator (albuterol)
What increase in FEV1 after given a bronchodilator is diagnostic of asthma?
12% or more
What is a good test to perform if a patient has normal baseline flows, but you are suspicious of asthma? How does it work?
Bronchoprovocation testing
- Inhale methacholine or mannitol
- Trying to trigger/induce asthma exacerbation
What is the Diagnostic Approach-Symptom categorization
- Sx frequency
- Nighttime awakening
- Need fo short acting beta-agonist
- Interference with normal activity
What medications do you want to avoid in asthma?
- ASA- Samter triad, nasal polyps
2. NSAIDs
Beta-2 Agonist MOA
Bronchodilator
-Relieve bronchospasm by relaxing bronchial smooth muscle
List short acting B-2 Agonists (SABA)
- Albuterol
- Pirbuterol
- Levalbuterol
When would you use a SABA?
- Emergently
2. Preventative- Exercise
What do you use a long acting B-2 Agonists (LABA) for?
PREVENTION
long acting B-2 Agonists (LABA) contraindications
- Not for rescue during acute exacerbation
2. Not a PRN inhaler
LABA black box warning
Long-acting B-agonists may increase the risk of asthma death when used alone= MUST USE WITH INHALED STEROID
What do you use an inhaled corticosteroid for?
- Decrease inflammation
- Preventative therapy
Benefit of a LABA and ICS combo inhaler
Long acting relief for:
Bronchospasm + Reduced inflammation
Leukotriene Receptor Antagonist MOA
-Blocks LT receptors, mitigates inflammation and mucosal edema effects
Leukotriene Receptor Antagonist example
Montelukast (Singulair)
Leukotriene Receptor Antagonist indication
Asthma + Allergies
Anticholinergics MOA
Decrease mucous secretions
Anticholinergics indication
acute exacerbation
Example of Anticholinergics
Ipratropium (Atrovent)
Monoclonal Antibody indications
- Severe Asthma
- Use in pulmonology office
Omalizumab (solaire) MOA
Recombinant antibody that binds IgE WITHOUT activating mast cell release
Reslizumab (Cinqair) & Mepolizumab (Nucala)
IL-5 antagonist monoclonal antibodies
Oral corticosteroid indications
- Acute exacerbation
2. Severe chronic sx’s
Methylxanthines/Phosphodiesterase (theophylline) inhibitors adverse reactions
Toxicity and adverse CV effects= avoid use!
What is the predicted average Peak Expiratory Flor Rate (PEFR) based on?
- Age
2. Height
After how long do you admit a pt to ICU for an acute asthma exacerbation?
4-6 hrs
Signs and sx’s of severe exacerbation
- Inability to speak full sentences
- Accessory muscle use
- Tri-pod positioning
- SpO2< 90%
Imminent respiratory arrest sx’s
- Confusion
- Cyanosis
- Fatigue
- Agitation
Rx treatment mid-moderate acute exacerbation
- O2 titrate up to SpO2>90%
2. Albuterol +/- Antcholinergic (Ipratropium)
Adjunct therapies severe acute exacerbation
- IV magnesium
- IV epinephrine
- Terbutaline
- Heliox
- Ketamine
- Neuromuscular blockers
Preventive care
- Pneumococcal vaccine prior to age 65
2. Annual influenza vaccine
