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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.

A

ICS

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
Q

Which body position, use of acessory muscles wheeze and functional assessment is a sign of imminent respiratory arrest?

A
  • 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); pCO2 (>42)
26
Q

On peak flow meter, which is not commonly used anymore, what is the red zone?

A

Less than 50% of usual or NL peak flow rate, signaling a medical alert.

27
Q

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?

A
  • Sx’s = ≤2 days/week
  • Nighttime awakenings = ≤2x/month
  • Use of SABA for sx’s = ≤2 days/week
  • NO interference w/ normal activity
28
Q

What is the lung function in a patient with intermittant asthma?

A
  • Normal FEV1 between exacertaions
  • FEV1 ( >80% of predicted)
  • FEV1/FVC ratio (NL)
29
Q

Moving from the intermittent category of asthma to the persistent category is an indication for the use of what?

A

Long-term preventative medicine such as ICS

30
Q

How many exacerbations of a pt’s asthma requiring oral systemic corticosteroids per year places them in the intermittent vs. persistent classification?

A
  • 0-1/year = intermittent
  • ≥2/year = persistent
31
Q

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?

A

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
Q

What determines the level of severity of asthma?

A
    1. Impairment
    1. Risk
33
Q

What is the initial at home tx for an asthma attack?

What about when symptoms worsen?

A

Inhaled SABA (albuterol)

  • If symptoms worsen = 2-6 puffs every 20 minutes for a max of 3 times.
34
Q

Going from intermittant asthma => step up, requires what change in medication.

After what step do you need specialist?

A

+ 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
Q

If pt has sx’s >2 days per week, which classification of asthma do they have?

A

Persistant

36
Q

What 4 things should you educate a patient on after starting them on medication for asthma?

A

- Treatment goals

- Inhaler technique

- Elimination of triggers

- Asthma action plan

37
Q

What are the 3 treatments use in combo for pt having exacerbation of their asthma (aka asthma attack)?

A
  1. SABA
  2. O2
  3. Oral corticosteroids
38
Q

What do doctors give to pediatric patients 0-5 so they know what they need to do to control asthma.

A

Child Asthma Action Plan;

not given at first visit, only when sure parents can handle it.

39
Q

Diagnosis of asthma in children younger than 2YO is _______.

Sxs?

A

Difficult.

  • Repeated wheezing episodes w no other cause
  • Family Hx and response to albuterol are commonly used to diagnose.
40
Q

Very poorly controlled asthma experiences how many symptoms and SABA uses how many times a day

A
  • throughout the day
  • seceraltimes a per day
41
Q
A

CPR Exam 3 (10 decks)

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