Asthma Flashcards
Asthma is the ___________ in childhood
most common chronic disease
Hospitalization rates highest in _____ and _______ population
children & black population
Death rates highest in ______ y/o blacks
15-24
What are the risk factors of asthma?
- ***Atopy (genetic tendency to develop allergies)
Atopic Triad:
- Eczema
- Asthma
- Atopic dermatitis
- Allergen exposure
- Fam hx
- Male child
- 20-40 M:F 1:1
- >40 F>M
- smoking
- viral illness
- obesity
What are the 3 main factors of Asthma pathophys?
- Airway hyperresponsiveness
- Inflammation
- Airflow obstruction & narrowing
What causes airway hyper-responsiveness?
- inhalants/allergens
- temp changes: humidity
- stress
- reflux: GERD
- exercise
What causes inflammation in asthma?
- eosinophils
- lymphocytes: T cells
- Neutrophils
- mast cell act.
- hyperplasia of goblet (mucus) cells
What causes airflow obstruction & narrowing?
- smooth muscle abnormality
- hypertrophy/hyperplasia
- decreased relaxation
- B-2 receptors
- Muscarinic receptors
Classic symptoms of Asthma
- wheezing
- cough
- dyspnea
Diagnosis of Asthma
- Hx of respiratory symptoms AND variable, reversible expiratory airflow obstruction
- AND H&P AND Spirometry
What will you see on a PE for a non-exacerbation pt?
- pale, swollen nasal mucosa? -> allergic rhinitis
- nasal polyps?
- eczema
- Cardiac: possible tachycardia
What is the GOLD STANDARD for dx asthma?
Spirometry/ Pulmonary Function Testing (PFT)
What is spirometry/PFT?
max inhalation followed by rapid and forceful, complete exhalation
“predicted values” are based on _____, _____ & ______
age, height, sex
What is FEV1?
Forced expiratory volume in 1 sec
FEV1 is _______ in obstructive dz
decreased
_____ is the normal value of FEV1
greater than or equal to 80% of predicted value
What is FVC?
forced vital capacity: amount of air forcefully exhaled after a maximal inhalation
FVC predicted value varies with ______ & ______
height & age
FVC normal value is…
greater than or equal to 80% of predicted
What does the FEV1/FVC ratio determine?
whether obstruction is present
What does an FEV1/FVC ratio <70% indicate?
obstructive disease
How does a normal pulmonary function graph differ from a severe airflow obstruction graph?
Normal pulmonary function is curved and severe airflow obstruction has a decreased slope
Predictive versus obstructive defect
Obstructive defect demonstrates scooping of the expiratory portion of the flow-volume curve compared with the predicted curve. The expiratory flow rate is reduced over most of the vital capacity.
Pre and post bronchodilatory measurements are done to determine _______
reversibility
Describe the steps of a pre and post bronchodilator measurement
- 2-4 puffs of SABA (albuterol)
- Wait 15 minutes
- Perform spirometry again
FEV1 increase of ____% or more = positive response to reversibility
12%
Asthma is _____ so PFT values may vary depending on patient status, therefore __________ are important in asthma.
episodic
serial measurements
What are some additional tests a pulmonologist would do?
- Bronchoprovication testing
- Total lung volume
- CBC: eosinophilia, anemia
- Serum IgE levels
- Allergy testing (IgE specific)
- ABG’s for acute settings
- Pulse O2
- Imaging
What kind of patients would you use Bronchoprovocation testing for?
Pts who do not have any signs of FEV1/FVC being less than 70% but are still symptomatic
Describe Bronchoprovocation testing
Pt would inhale methacholine or mannitol, which challenges their airways
You would see how the patient reacts
How would you measure total lung volume?
Helium dilution
Plethysmography
Asthma therapy is based on severity of which 4 symptoms?
- symptom frequency
- Nighttime awakenings
- need for SABA
- inferference with normal activity
Categorize pts symptoms by the _______ symptom/parameter
MOST SEVERE
What is the normal FEV1/FVC % for 8-19 y/o?
85%
What is the normal FEV1/FVC % for 20-39 y/o?
80%