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CPR Exam 3 > Asthma > Flashcards

Asthma Flashcards

1
Q

Asthma is characterized by a limitation of airflow on which clinical tests?

A
  • PFT

or

  • Positive bronch-provocation challenge (i.e., methacholine challenge)
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2
Q

What are the essentials of asthma diagnosis?

A
  • Chronic or episodic airflow obstruction** that is **reversible (spontaneous or via bronchodilator).
  • Worse at night or early in the morning
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3
Q

What findings occur during PE of asthma?

A
  • Prolonged expirations and diffuse wheezes.
    • If severe airway obstruction, cannot hear anything
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4
Q

Bronchoprovication challange is often performed by a _________.

A

Pulmonologist or specialist, not a PCP.

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5
Q

What are the 5 clinical symptoms of asthma?

A
  1. Cough
  2. Wheezing
  3. Tight chest
  4. Prolonged exhalation
  5. SOB
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6
Q

In the absence of relavant findings during PE, what are the top 2 DDx of night coughing?

A

1. Bronchospasms

2. Post-nasal drip.

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7
Q

What are the walls of the airway like in an asthmatic and what occurs to the airway during an asthmatic attack?

A
  • Walls = inflammed and thickened
  • During attack = tightened smooth ms.
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8
Q

What findings do we see in status asthmaticus?

A
    1. Curschmann spirals, thick mucus plugs from subepithelial mucus glands, in sputum or bronchoalveolar lavages.
    1. Charcot-Leyden cystals, made up of eosinophil protein called galectin-10.
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9
Q

What happens to airways in patients with chronic asthma?

A

Airway remodeling, which is irreversible.

  1. Thickening of wall
  2. Sub-BM fibrosis
  3. ↑ vascularity
  4. ↑ in size of submucosal glands and # of goblet cells
  5. Hypertophy/hyperplasia of bronchial wall muscle
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10
Q

What is the strongest predisposing factor to asthma?

A

Atopy, the genetic tendency to develop [allergies, asthma and eczema].

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11
Q

List common triggers for asthmatics

A

Inhaled allergens

    1. Dust mites
    1. Roaches
    1. Seasonal pollen
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12
Q

Non-specific triggers (non-atopic) for asthma (10)

A
  1. XRCISE
  2. URI
  3. Sinusitis
  4. Allergic rhinitis
  5. Aspiration
  6. GER
  7. Pollulation
  8. Meds (ASA and NSAID)
  9. Occupational
  10. Obesity
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13
Q

It is really unsual to have a new diagnosis of asthma in patients _________.

A

Older than 50

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14
Q

What is difference in terms of airflow limitation (FEV1 and FEV1/FVC) reversibility in asthma vs. COPD?

A
  • Asthma = reversible
  • COPD = partially reversible; irreversible w/ significant disease
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15
Q

What is this flow-volume curve indicative of?

A

Asthma (pre-bronchodilator)

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16
Q

What is this flow-volume curve indicative of?

A

Vocal Cord Dysfunction.

Takes longer to take a full deep breath in, sometimes making a weezy stridor sound due to upper airway.

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17
Q

Who is most likely to have a vocal cord dysfunction?

A

Tall, thin, young women

Ex. Cross country runners

18
Q

What is A, B and C?

A

A) Normal

B) Obstructive (i.e., asthma or COPD)

C) Restrictive (total volume is lower

19
Q

What are the primary quick relief asthma medications?

A
  1. Short-acting B2 agonists (albuterol, levalbuterol; has fewer SE)
20
Q

What are other examples of short acting asthma medications?

A
  1. Anticholinergics
    1. Ipatropium (atrovant); used with albuterol ONLY in the first 24 hours after an acute attack
  2. Systemic corticosteroids by IV or PO
    1. Methylprednisolone
    2. Prednisolone
    3. Prednisone
21
Q

______ are to never be used as rescue medications.

22
Q

What are 2 classes of drugs which are great for long-term control of asthma?

A
  1. Inhaled corticosteroids
    • Fluticasone, beclomethasone, budesonide
  2. Leukotriene modifiers (i.e., montelukast, zafirlukast, zileuton)
23
Q

Other long term control asthma medications (5)

A
    1. Inhaled LABA
    1. Mast cell stabilizers
    1. Inhaled long-acting anticholinergic (tiopropium)
    1. Methylxanthines (theophylline)
    1. Immunomodulators (omalizumab; SQ)
24
Q

Whichs symptoms, RR and HR is a sign of imminent respiratory arrest?

A
  • Sx = Breathlessness at rest (mute), quiet, drowsy or confused
  • RR = >30/minute
  • HR = bradycardia
25
Which body position, use of acessory muscles wheeze and functional assessment is a sign of **imminent respiratory arrest?**
- **Body position** = cannot recline - **Use of accessory muscles** = paradoxical thoracoabdominal movement - **Wheeze** = absent - **Pulsus paradoxus** = absent, suggesting fatigue of respi muscles - **FA** = _FEV1_ is \< 25% of predicted; _PaO2_ (\<60; possible cyanosis); p**_CO2_** (\>42)
26
On **peak flow meter,** which is _not_ commonly used anymore, what is the red zone?
Less than 50% of usual or NL peak flow rate, signaling a **medical alert.**
27
What are the criteria for days per week w/ sx's, nighttime awakenings, use of SABA for sx control, and interference with normal activity for asthma to be classfied as **intermittent asthma**?
- **Sx's** = ≤2 days/week - **Nighttime awakenings** = ≤2x/month - **Use of SABA for sx's** = ≤2 days/week - NO interference w/ normal activity
28
What is the lung function in a patient with **intermittant asthma**?
- **Normal FEV1** between exacertaions - **FEV1** ( \>80% of predicted) - **FEV1/FVC ratio** (NL)
29
Moving from the intermittent category of asthma to the persistent category is an indication for the use of what?
**Long-term preventative medicine such as ICS**
30
How many exacerbations of a pt's asthma requiring oral systemic corticosteroids per year places them in the **intermittent** vs. **persistent** classification?
- **0-1/year** = intermittent - **≥2/year** = persistent
31
Pts who had **≥2 exacerbations requiring oral systemic glucocorticoids** in the past year may be considered the same as patients who have what classification of asthma; even in the absence of what?
**Persistent asthma**.. even in the absence of impairment levels consistent with persistent asthma or even if they fulfill all other requirements of **intermitant asthma.**
32
What determines the level of severity of asthma?
* 1. **Impairment** * 2. **Risk**
33
What is the initial at home tx for an asthma attack? What about when symptoms worsen?
**Inhaled SABA (albuterol)** * **If symptoms worsen** = 2-6 puffs every 20 minutes for a max of 3 times.
34
Going from intermittant asthma =\> step up, requires what change in medication. After what step do you need specialist?
+ a **low-dose ICS (step 2)** * **Step 3:** (+ LABA or medium dose ICS) * **Step 4:** (Medium dose ICS + LABA); *add specialist from here on* * **Step 5:** (High dose ICS + LABA) * **Step 6:** (High dose ICS + LABA + oral corticosteroids)
35
If pt has sx's \>2 days per week, which classification of asthma do they have?
**Persistant**
36
What 4 things should you educate a patient on after starting them on medication for asthma?
**- Treatment goals** **- Inhaler technique** **- Elimination of triggers** **- Asthma action plan**
37
What are the **3 treatments** use in combo for pt having exacerbation of their asthma (aka **asthma attack**)?
1. **SABA** 2. **O2** 3. **Oral corticosteroids**
38
What do doctors give to pediatric patients 0-5 so they know what they need to do to control asthma.
**Child Asthma Action Plan;** not given at first visit, only when sure parents can handle it.
39
Diagnosis of asthma in children younger than 2YO is \_\_\_\_\_\_\_. Sxs?
**Difficult.** - Repeated wheezing episodes w no other cause - Family Hx and response to albuterol are commonly used to diagnose.
40
Very poorly controlled asthma experiences how many symptoms and SABA uses how many times a day
- throughout the day - seceraltimes a per day
41

CPR Exam 3 (10 decks)

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