Asthma

Question 1

What is the gold standard for diagnosing Asthma?

Answer 1

Pulmonary Function Testing:
REVERSIBLE obstruction
-Decreased FEV1
-Decreased FEV1/FVC

Question 2

If a suspected asthma patients PFTs are nondiagnostic, what alternate study can be used?

Answer 2

Methacholine challenge test: > or = 20% decrease in FEV1
+
Bronchodilator challenge test: > or = 12% increase in FEV1 (> or = 200cc)

OR
Exercise challenge test: > or = 15% decrease in FEV1
*Histamine may also be used

Question 3

What is the best and most objective way to assess an asthma exacerbation severity and a patients response in the ED?

Answer 3

Peak Expiratory Flow Rate (PEFR)

PEFR > 15% from initial attempt = response to treatment

Question 4

What is a normal Peak Expiratory Flow Rate?

Answer 4

400-600

Question 5

What O2 saturation is indicative of respiratory distress?

Answer 5

<90%

Question 6

In a patient with an exacerbation of Asthma, why should you keep an eye on their ABGs?

Answer 6

Because there may be pseudonormalization

-Increased CO2 may indicate impending respiratory failure

Question 7

What are admission criteria for a patient with an asthma exacerbation?

Answer 7

1. PEFR <50%: FEV <1L; PEFR <15%
2. ER visit w/in 3 days of exacerbation
3. Status asthmaticus
4. Posttreatment failure
5. AMS

Question 8

What are discharge criteria for a patient iwth an exacerbation of asthma?

Answer 8

1. PEFR >70% predicted: PEFR >15%
2. Subjective improvement
3. Clear lungs with good air movement
4. Adequate follow up within 24-72 hrs
5. Response sustained 1 hr after treatment

Question 9

What is the classic Asthma triad seen on PE?

Answer 9

1. Dyspnea
2. Cough (esp at night)
3. Wheezing

Question 10

What is Samter’s triad?

Answer 10

1. Asthma
2. Nasal polyps
3. ASA/NSAID allergy

-associated with Atopic dermatitis

Question 11

What is a risk factor for asthma?

Answer 11

Atopy

Question 12

What is the MC chronic childhood disease?

Answer 12

Asthma