Asthma Flashcards
Essentials of asthma diagnosis
Reversibility of airflow obstruction, either spontaneously or following bronchodilator therapy
Limitation of airflow on pulmonary function testing or positive broncho-provocation challenge [methacholine challenge]
What changes occur with the walls of the airway with asthma?
Walls become inflamed and thickened + tightened smooth muscle
How does exposure to allergens trigger asthma?
Mast cells release leukotrienes which contribute to smooth muscle constriction
Characteristic findings in sputum or bronchoalveolar lavage in prolonged status asthmaticus
Curschmann spirals — extrusion of mucus plugs from subepithelial mucus gland ducts or bronchioles
Charcot-Leyden crystals — composed of protein called galectin 10
What is the strongest predisposing factor to developing asthma?
Atopy
Triggers include exposure to inhaled allergens — dust mites, cockroaches, seasonal pollens
Atopic triangle = Asthma, allergies, eczema — if there is a history of one, there are likely others
How is COPD differentiated from bronchial asthma based on FEV1 and FEV1/FVC ratio return to normal?
After drug therapy, these values should normalize in an asthmatic patient [asthma is considered reversible]
There is unlikely to be improvement in a pt with significant COPD
In differentiating asthma from COPD, what are some key indicators that it is asthma?
Wheezing (especially in children — COPD is usually diagnosed later)
Hx of cough or recurrent wheezing, difficulty breathing, chest tightness
Symptoms occur/worsen in presence of exercise, viral infection, change in weather, strong emotional expression, menstrual cycles, or potential allergens
Symptoms occur/worsen at night (awakening patient)
Asthma typically displays on flow-volume loop with ________-appearance
“Scooped out”
If you have a patient who appears to have asthma, but they are not responding to asthma medications — and spirometry shows truncated inspiratory loop (and no “scooped out” appearance that would indicate asthma), what diagnosis should you be considering?
Vocal cord dysfunction
The rescue medication for asthma always includes what class?
Short acting beta2 agonist — likely albuterol or levalbuterol
What are the long term control medications for asthma?
Inhaled corticosteroids
Leukotriene modifiers
[other options include inhaled LABAs, cromolyn and nedocromil, tiotropium, methylxanthines, immunomodulators]
Signs/symptoms that respiratory arrest is imminent
Breathlessness at rest
Not able to speak
Appear drowsy or confused
RR >30/min (or in infants >60/min)
Unable to recline
Paradoxical thoracoabdominal movement
Wheezing absent, bradycardia
FEV <25%, PaO2 <60, possible cyanosis, PCO2>42, O2 sat <90
When an asthma patient goes from the _______ to the _____ category, it is an indication for long term preventative medicine like an ICS
Intermittent; persistent
Symptoms, nighttime awakenings, SABA use, and interference with normal activity associated with asthma classified as intermittent
Symptoms <2 days/week
Nighttime awakenings <2x/month
SABA use <2 days/week
No interference with normal activity
An asthma patient’s risk is based on exacerbations requiring oral systemic corticosteroids. What are the criteria for intermittent vs. persistent classification?
Intermittent risk = 0-1x/year
Persistent = 2+/year
Key aspects of education in asthma patients/their parents
Treatment goals
Inhaler techniques
Elimination of triggers
Asthma action plan
In a pt with acute asthma exacerbation, if breath sounds prior to treatment are diminished with very faint expiratory wheezes, and after treatment there is increased wheezing - it is a sign of ______
Improvement
A previously healthy 2 y/o girl presents with the complaint of acute onset wheezing. Her mother denies previous wheezing episodes and denies a FH of asthma or atopy. The mother says that she left the child playing in her older brother’s room. Approx. 20 min later, she heard the child coughing and wheezing. Which of the following is the best next step in management?
A. Determining what the girl was playing with and order a CXR
B. Refer the child to a pulmonologist
C. Prescribe abx for PNA
D. Administer IM prednisone and send her home
E. Accuse mom of poor supervision
A. Determine what the girl was playing with and order a CXR
A 14 y/o girl develops acute onset SOB with exercise. The SOB resolves fairly quickly after cessation of exercise. Her discomfort is associated with breathing in vs. breathing out. She is an accomplished athlete with a thin body habitus. She doesn’t have a previous hx of asthma or FH of asthma. Which of the following is the most likely dx?
A. Asthma B. FB aspiration C. GERD D. Oropharyngeal dysphagia with aspiration E. Vocal cord dysfunction
E. Vocal cord dysfunction
A 10 y/o boy on the junior high track team develops difficulty breathing associated with documented wheezing when running. He never experiences these sxs other than when running. Which of the following meds is the first-line therapy for this child?
A. LABA before exercise
B. SABA before exercise
C. Inhaled corticosteroid before exercise
D. Leukotriene inhibitor
E. Mast cell stabilizing medication before exercise
B. SABA before exercise
A 5 y/o girl is given a new dx of asthma. After a brief discussion with her parents, the doc prescribes several meds. Which of the following is MOST likely not to be filled by her parents?
A. LABA B. SABA C. ICS D. Leukotriene inhibitor E. Mast cell-stabilizing medication
C. ICS
[parents are often hesitant to give child steroids]
A 4 y/o boy is newly dx as having mild persistent asthma. His parents are concerned about AEs of ICS medications. Which of the following is recommended to reduce these?
A. Distilled water in nebulizer B. Rinse mouth before inhalation C. Rinse mouth after inhalation D. Oral nystatin daily E. Spacer with MDI
C. Rince mouth after inhalation
