Asthma Flashcards
does asthma primarily affect children or adults?
children (10%)
what percent of adults have asthma?
6%
what is the life of the disease?
- many cases spontaneously resolve after puberty
- progress to COPD
asthma
- inflammatory airway disease with an exaggerated contractile response
- secondary to variety of stimuli
how is asthma characterized?
REVERSIBLE episodes of hyperresponsiveness
- difficulty breathing
- coughing
- wheezing
pathophysiology of asthma
- contraction of airway smooth m.
- thickening of airway wall secondary to inflammatory response
- plugging of airway with mucous
asthma pts experience decreased airway diameter + increased airway resistance =
difficulty with EXPIRATION
etiology of asthma
environment + genetic susceptibility
unavoidable triggers of asthma
- respiratory tract illnessess
- physical exertion
- hormonal fluctuations
- extreme emotion
asthma triggers that can be addressed/treated
- inhaled allergens
- respiratory irritants
- comorbid conditions
- medications
- influenza
- pneumococcal infection
- dietary sulfites
Aspirin and NSAIDS will exacerbate symptoms in what percentage of asthmatic pts?
3-5%
medical management of asthmatic pts
- routine management of syms and lung fxn
- pt education
- control environmental factors and comorbid conditions that contribute to asthma severity
- pharmacologic therapy
goals of medical management of asthmatic pts
- reduce impairment
- reduce risk
what is considered reduce impairment of asthmatic pts?
- freedom from frequent syms
- minimal need (≤2d/wk) of inhaled short-acting beta agonists to relieve syms
- maintenance of normal daily activities, including athletics and exercise
why do you want to reduce risk of asthmatic pts?
- prevent recurrent exacerbations and ED care
- optimization of pharmacotherapy with minimal or no adverse effects
pharmacologic management of intermittent asthmatic pts
inhaled quick-acting beta-2 agonists prn
what is the most common asthma inhaler?
Albuterol - has least CV effects
pharmacologic management of persistent asthmatic pts
- inhaled glucocorticoids scheduled
- inhaled quick-acting beta-2 agonists prn
can inhaled glucocorticoids be used in emergencies?
no, they’re slow acting - takes a couple of hours to take effect
inhaled glucocorticoids
steroid that decreases inflammation within airway
additional drugs that asthmatic pts can be prescribed?
- leukotriene inhibitors
- inhaled long-acting beta-2 agonists
character of well-controlled asthma
- daytime syms no more than 2x/month
- nighttime syms no more than 2x/month
- short acting B agonists for relief of asthma symptoms needed <3d/wk
- no interference w normal activity
- oral steroids courses and/or urgent care visits no more than 1x/yr
character of severe disease
- frequent exacerbations
- exercise intolerance
- multiple scheduled meds
- ED visits
assessment of risk factors for future exacerbations
- oral glucocorticoids for asthma in last yr
- hospitalized in last yr
- admitted to intensive care or intubated within past 5 yrs
- current cig smoker
- increase in asthma syms after taking Aspirin or NSAIDS
asthmatic pt that are not a candidate for elective care
- current syms such as SOB, wheezing, increased respiratory rate
- +/- poor compliance with drug therapy
- ED visit within last 3 months
mods to dental care
- remind pts to take regularly scheduled meds and bring emergency inhaler with them
- stress/anxiety management, N2O sedation
- avoid Aspirin/NSAIDS
arachidonic acid produces which enzymes
- lipoxygenase
- cyclooxygenase (COX-1 and COX-2)
leukotrienes trigger what?
anaphylactoid syndromes
COX-1 acts on what?
- prostaglandins
- thromboxane A2
COX-2 acts on what?
- prostaglandins
- prostacyclin
role of prostaglandins (COX-1)
- gastric mucosal barrier
- renal fxn
role of thromboxane A2
- platelet aggregation
- vasoconstriction
role of prostaglandins (COX-2)
- pain, inflammation, fever
- renal fxn
role of prostacyclin
- platelet inhibition
- vasodilation
Aspirin and NSAIDS block which enzyme?
cyclooxygenases (COX-1 and COX-2)
syms of asthma attack
- breathlessness
- wheezing
- cough
- chest tightness
asthma attack
- sudden onset with peak syms after 10-15 mins
- typically self-limiting
treatment of asthma attack
- inhaled short-acting beta-2 agonists
- 2-8 puffs, repeat Q20 mins
- supportive care via O2 and vitals
- activate EMS prn
what is used to treat acute broncospasm
- beta-2 adrenergic agonist, albuterol
status asthmaticus
- severe, prolonged asthma attack (>24 hrs)
- can lead to exhaustion, dehydration, peripheral vascular collapse, death
- true medical emergency
status asthmaticus is associated with what?
respiratory infection
T/F: pts with asthma have no issue getting O2 in but have a problem getting rid of CO2?
true
