Asthma Flashcards
Asthma is characterized by a limitation of airflow on which clinical tests?
- PFT
or
- Positive bronch-provocation challenge (i.e., methacholine challenge)
What are the essentials of asthma diagnosis?
- Chronic or episodic airflow obstruction** that is **reversible (spontaneous or via bronchodilator).
- Worse at night or early in the morning
What findings occur during PE of asthma?
-
Prolonged expirations and diffuse wheezes.
- If severe airway obstruction, cannot hear anything
Bronchoprovication challange is often performed by a _________.
Pulmonologist or specialist, not a PCP.
What are the 5 clinical symptoms of asthma?
- Cough
- Wheezing
- Tight chest
- Prolonged exhalation
- SOB
In the absence of relavant findings during PE, what are the top 2 DDx of night coughing?
1. Bronchospasms
2. Post-nasal drip.
What are the walls of the airway like in an asthmatic and what occurs to the airway during an asthmatic attack?
- Walls = inflammed and thickened
- During attack = tightened smooth ms.
What findings do we see in status asthmaticus?
- Curschmann spirals, thick mucus plugs from subepithelial mucus glands, in sputum or bronchoalveolar lavages.
- Charcot-Leyden cystals, made up of eosinophil protein called galectin-10.
What happens to airways in patients with chronic asthma?
Airway remodeling, which is irreversible.
- Thickening of wall
- Sub-BM fibrosis
- ↑ vascularity
- ↑ in size of submucosal glands and # of goblet cells
- Hypertophy/hyperplasia of bronchial wall muscle
What is the strongest predisposing factor to asthma?
Atopy, the genetic tendency to develop [allergies, asthma and eczema].
List common triggers for asthmatics
Inhaled allergens
- Dust mites
- Roaches
- Seasonal pollen
Non-specific triggers (non-atopic) for asthma (10)
- XRCISE
- URI
- Sinusitis
- Allergic rhinitis
- Aspiration
- GER
- Pollulation
- Meds (ASA and NSAID)
- Occupational
- Obesity
It is really unsual to have a new diagnosis of asthma in patients _________.
Older than 50
What is difference in terms of airflow limitation (FEV1 and FEV1/FVC) reversibility in asthma vs. COPD?
- Asthma = reversible
- COPD = partially reversible; irreversible w/ significant disease
What is this flow-volume curve indicative of?
Asthma (pre-bronchodilator)
What is this flow-volume curve indicative of?
Vocal Cord Dysfunction.
Takes longer to take a full deep breath in, sometimes making a weezy stridor sound due to upper airway.
Who is most likely to have a vocal cord dysfunction?
Tall, thin, young women
Ex. Cross country runners
What is A, B and C?
A) Normal
B) Obstructive (i.e., asthma or COPD)
C) Restrictive (total volume is lower
What are the primary quick relief asthma medications?
- Short-acting B2 agonists (albuterol, levalbuterol; has fewer SE)
What are other examples of short acting asthma medications?
-
Anticholinergics
- Ipatropium (atrovant); used with albuterol ONLY in the first 24 hours after an acute attack
-
Systemic corticosteroids by IV or PO
- Methylprednisolone
- Prednisolone
- Prednisone
______ are to never be used as rescue medications.
ICS
What are 2 classes of drugs which are great for long-term control of asthma?
-
Inhaled corticosteroids
- Fluticasone, beclomethasone, budesonide
- Leukotriene modifiers (i.e., montelukast, zafirlukast, zileuton)
Other long term control asthma medications (5)
- Inhaled LABA
- Mast cell stabilizers
- Inhaled long-acting anticholinergic (tiopropium)
- Methylxanthines (theophylline)
- Immunomodulators (omalizumab; SQ)
Whichs symptoms, RR and HR is a sign of imminent respiratory arrest?
- Sx = Breathlessness at rest (mute), quiet, drowsy or confused
- RR = >30/minute
- HR = bradycardia
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); pCO2 (>42)
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.
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
What is the lung function in a patient with intermittant asthma?
- Normal FEV1 between exacertaions
- FEV1 ( >80% of predicted)
- FEV1/FVC ratio (NL)
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
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
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.
What determines the level of severity of asthma?
- Impairment
- Risk
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.
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)
If pt has sx’s >2 days per week, which classification of asthma do they have?
Persistant
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
What are the 3 treatments use in combo for pt having exacerbation of their asthma (aka asthma attack)?
- SABA
- O2
- Oral corticosteroids
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.
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.
Very poorly controlled asthma experiences how many symptoms and SABA uses how many times a day
- throughout the day
- seceraltimes a per day
