Asthma Flashcards
Asthma is most common in…
Male kids, Adult women, A.A., and Children
Obstructive asthma is a result of what physiologic disturbance?
Small airway inflammation / bronchoconstriction. Air cannot get out!
What are some risk factors / causes of asthma?
Viral infection (RSV before 1st year of age)
Genetics (Family Hx especially mother)
Allergens
Exposure to tobacco smoke / poor air quality
PMHx: GERD, allergies, or eczema
Most bronchoconstriction is mediated by what?
IgE mediated
What is the strongest predisposing factor to the development of asthma?
Atopy (the propensity for IgE responsiveness to environment)
Asthma attacks typically present with what clinical signs/symptoms?
SOB
Cough (dry, non-productive)
Wheezing
Chest Px
Wheezing with asthma is most commonly auscultated at which point during the PT’s breathing cycle?
End Expiratory!!!!
What is the gold standard for Dx of Asthma?
SPIROMETRY
>12% increase in FEV1 after bronchodilator
>200mL increase in FEV1 after bronchodilator
What class of medications can cause a cough in PT’s and should be ruled out as you obtain your PT’s Hx (if you’re thinking asthma)?
ACE-Inhibitors (Captopril, Lisinopril, etc)
What determines the initial treatment for your patient?
SEVERITY of the asthma
What are the age categories / breakdowns for asthma Tx?
<4 y.o.
5 to 11
12 and older
Further Determine –> Intermittent or Persistent (Mild, moderate, or severe)
What is a good measurement to monitor asthma control in patients long term?
The Peak Expiratory Flow Rate (PEFR)
Because it represents getting air out; and asthma is obstructive in nature (difficult to push air out)
PEFR should be conducted how often and within what range for PT baseline normal?
2-4x per day for 2 weeks
Normal range is 80 to 100%
What is the preferred long-term control treatment for everyone?
INHALED CORTICOSTEROIDS
(i.e.
When stepping up therapy; what should you give a PT if they are >12 years of age?
ICS + LABA
What are two examples of mast cell stabilizer therapies?
Cromolyn
Nedocromil
When should you step up a PT’s therapy?
When should you step down a PT’s therapy?
Step up if symptoms 2x per week or 2x at night/ in one month
Step Down if: No asthma exacerbations in 2 to 3 months
What are some examples of ICS therapies?
Bud –> Budesonide (Pulmicort)
Beck –> Beclomethasone (Qvar)
Flu –> Fluticasone (Flovent)
Mom –> Mometasone (Asmanex)
T/F
Long Acting Beta2 Agonists are prescribed as a monotherapy for PTs who need stepped up from ICS.
False
Never give LABAs as monotherapy
(usually come together ICS + LABA)
Advair (Fluticasone / Salmeterol)
Dulera (Mometasone / Formoterol)
Symbicort (Budesonide / Formoterol)
What is an example of an Anti-IgE medication which can be given to PTs and when would it be indicated?
Step 5 or 6 of Asthma Therapy
OMALIZUMAB (Anti-IgE)
T/F
If you use a SABA twice a week; you do not have adequate control of your asthma.
True
SABA: Albuterol q4-6hrs
Xopenex (Levalbuterol) q8hrs
If the SABA inhaler you Rx’d your patient is not being tolerated well; what else can you prescribe?
Ipratropium (Anticholinergic)
What is Sampter’s Triad?
ASA sensitivity
Asthma
Nasal Polyps
