Asthma Flashcards
how does a pulmonary insult impact a child with asthma?
it makes asthma significantly worse (exacerbation occurs)
is wheezing always present in an asthmatic pt?
no
If a patient responds to these two types of drugs, they probably have asthma
oral steroids and bronchodilators
what two things is asthma often associated with?
allergies and family history
what is a good way to help improve someone’s asthma if they have allergies?
remove the allergy triggers as much as possible
according to Hadley, below what % O2 sat (for asthma) is when we would start worrying about hospital admittance
92%
Coughing at what time of day is indicative of asthma
at night
for a patient with persistent asthma, what type of med will they always be on?
ICS
what time in life does asthma develop?
it always develops in childhood, unless some occupational cause
what % of children with asthma have allergies?
80%
about how many American children and adults have asthma?
- 2 million kids
18. 4 million adults
what age of people are most likely to have more ED visits and end up admitted because of asthma?
0-4 years old
death by asthma increases with _______
age
does severity of asthma predict death?
NO
with more adherent use of _______ medications, asthmatic patient’s risk of death goes down
ICS
what is the definition of asthma?
a CHRONIC lung disease characterized by REVERSIBLE BRONCHOCONSTRICTION and INFLAMMATION of the airways
what happens to the airway lumen after an allergen challenge?
lumen rapidly narrows (bronchoconstriction)
what are signs and symptoms of asthma?
cough(esp nighttime), wheeze (sometimes), SOB, chest tightness
what three things do you use to diagnose asthma? What two things do you not use?
History, PE, and spirometry ( 4 yrs and older)
-don’t use: PFM (good for monitoring not diagnosing) or CXR
what are 4 goals for asthma care by EPR-3?
1) . look for triggers
2) . written action plan
3) . planned care
4) . educate the patient
what are 4 things you might see on an asthmatic patient’s PE?
1) . respiratory distress (maybe)
2) . wheezing (maybe)
3) . prolonged expiratory phase
4) . maybe allergies
compare mild versus worse wheezing on a PE
mild- will see a late expiratory phase
worse- earlier wheeze on expiration than mild and maybe hear one during the inspiratory phase
hearing a wheeze upon inspiration is a sign of what?
obstruction
what is the best test done for asthma?
spirometry
adults (greater than 12 yrs old) with intermittent asthma have how many symptoms, nighttime awakenings, SABA uses, & inference with normal activity? describe lung function
symptoms- less than 2 days/week nighttime- less than 2 per month SABA use- less than 2 days per week no interference with normal activity lung function- normal FEV1, normal FEV1/FVC ratio
persistent asthma is divided into what three classifications?
mild, moderate, and severe
mild adults asthmatics have how many symptoms, nighttime awakenings, SABA uses, & inference with normal activity? describe lung function
symptoms- greater than 2 days per week but not daily
nighttime- 3-4/month
SABA use- more than 2 days/week but not daily (not more than once a day)
minor limitation with daily activity
lung function: FEV1 < 80%, FEV1/FVC normal
moderate adults asthmatics have how many symptoms, nighttime awakenings, SABA uses, & inference with normal activity? describe lung function
symptoms- daily nighttime- >1x/week but not nightly SABA use- daily some limitation with daily activity lung function: FEV1 >60% and < 80%, FEV1/FVC reduced 5%
severe adults asthmatics have how many symptoms, nighttime awakenings, SABA uses, & inference with normal activity? describe lung function
symptoms- throughout the day nighttime- often 7x per week SABA use- several times per day extremely limited with daily activity lung function: FEV1 <60%, FEV1/FVC reduced >5%
what is the difference between intermittent and persistent asthma?
intermittent asthma has been going on for less than a year, whereas persistent is greater than 2 years
what is the baseline tx for intermittent asthma?
SABA (2 puffs every 4-6 hrs PRN, based on symptoms)
what is highly important in inhaler use?
technique of use
SABA inhaler is also known as ____________
a rescue inhaler
what is the cheapest SABA and less side effects
levalbuterol (left sided isomer)
what else besides SABAs can be used for a rescue asthma situation?
ICS or oral steroids
what is the drug of choice for treating persistent asthma?
ICS- most potent and consistently effective
what are 5 benefits of ICS?
reduce symptom severity, improve asthma control, improve lung function, reduce airway hyperresponsiveness, prevent exacerbations
what statistic is reduced the more patients refill their low dose ICS canisters per year?
death in these patients decrease with more low dose ICS use
what type of long term asthma med must be used in combo with ICS?
LABAs
what is the purpose of using ICS/LABA drugs together?
to help maintenance of long term asthma (twice daily) but NOT indicated for relief of acute bronchospasm
what type of asthma drugs are given to poorly controlled patients & are a way to avoid chronic oral steroids?
biologics (umab’s)- also considered “last ditch” med for allergic pathway
when a patient is using a nebulizer every day, what is that a sign of?
poorly controlled asthma because they need a higher dose to overcome symptoms rather than a better lower dose regimen
explain tx of asthma for step 2-6 (persistent asthma)
2: low dose ICS
3: low dose ICS + LABA or medium dose ICS
4: medium dose ICS + LABA
5: High dose ICS + LABA + consider umab for allergy pt
6: high dose ICS + LABA + OCS + consider umab for allergy pt
what is important to remember in the tx of asthma?
you want to keep assessing control and step up or down treatments as needed
when is the only case to use LABA’s alone?
pretreating for long distance exercise
when is it ok to use SABAs more than 2x/week
when pretreating for exercise
what are 4 important steps in tx asthma exacerbations in urgent care/ED?
1) . O2 & pulse ox
2) . SABA w ipratropium by nebulizer
3) . systemic steroids 4-5 days (oral or IV)
4) . upon discharge- follow up with provider and oral steroids for 5-10 days
what is hadleys rule of thumb about asthmatic children who come to the drs?
if they are sick enough to come in, they should probably have steroids
when patients with moderate persistent asthma evaluate their control, what % predict it is well controlled?
61% (not true- pts bad at eval)
when patients with severe persistent asthma evaluate their control, what % predict it is well controlled?
32% (not true- pts bad at eval)
what is the rule of twos mean?
it signifies poorly controlled asthma daytime symptoms- >2 days/week nighttime symptoms- >2 days/month Rescue SABA canister- >2/year Rescue SABA use- >2x/week
what are the three zones of the asthma action plan?
based on peak flow meter values
Green: >80%
Yellow: 50-80%
Red: <50%
