Asthma

Question 1

Asthma is most common in…

Answer 1

Male kids, Adult women, A.A., and Children

Question 2

Obstructive asthma is a result of what physiologic disturbance?

Answer 2

Small airway inflammation / bronchoconstriction. Air cannot get out!

Question 3

What are some risk factors / causes of asthma?

Answer 3

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

Question 4

Most bronchoconstriction is mediated by what?

Answer 4

IgE mediated

Question 5

What is the strongest predisposing factor to the development of asthma?

Answer 5

Atopy (the propensity for IgE responsiveness to environment)

Question 6

Asthma attacks typically present with what clinical signs/symptoms?

Answer 6

SOB
Cough (dry, non-productive)
Wheezing
Chest Px

Question 7

Wheezing with asthma is most commonly auscultated at which point during the PT’s breathing cycle?

Answer 7

End Expiratory!!!!

Question 8

What is the gold standard for Dx of Asthma?

Answer 8

SPIROMETRY
>12% increase in FEV1 after bronchodilator
>200mL increase in FEV1 after bronchodilator

Question 9

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)?

Answer 9

ACE-Inhibitors (Captopril, Lisinopril, etc)

Question 10

What determines the initial treatment for your patient?

Answer 10

SEVERITY of the asthma

Question 11

What are the age categories / breakdowns for asthma Tx?

Answer 11

<4 y.o.
5 to 11
12 and older
Further Determine –> Intermittent or Persistent (Mild, moderate, or severe)

Question 12

What is a good measurement to monitor asthma control in patients long term?

Answer 12

The Peak Expiratory Flow Rate (PEFR)

Because it represents getting air out; and asthma is obstructive in nature (difficult to push air out)

Question 13

PEFR should be conducted how often and within what range for PT baseline normal?

Answer 13

2-4x per day for 2 weeks

Normal range is 80 to 100%

Question 14

What is the preferred long-term control treatment for everyone?

Answer 14

INHALED CORTICOSTEROIDS

(i.e.

Question 15

When stepping up therapy; what should you give a PT if they are >12 years of age?

Answer 15

ICS + LABA

Question 16

What are two examples of mast cell stabilizer therapies?

Answer 16

Cromolyn

Nedocromil

Question 17

When should you step up a PT’s therapy?

When should you step down a PT’s therapy?

Answer 17

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

Question 18

What are some examples of ICS therapies?

Answer 18

Bud –> Budesonide (Pulmicort)
Beck –> Beclomethasone (Qvar)
Flu –> Fluticasone (Flovent)
Mom –> Mometasone (Asmanex)

Question 19

T/F

Long Acting Beta2 Agonists are prescribed as a monotherapy for PTs who need stepped up from ICS.

Answer 19

False

Never give LABAs as monotherapy

(usually come together ICS + LABA)
Advair (Fluticasone / Salmeterol)
Dulera (Mometasone / Formoterol)
Symbicort (Budesonide / Formoterol)

Question 20

What is an example of an Anti-IgE medication which can be given to PTs and when would it be indicated?

Answer 20

Step 5 or 6 of Asthma Therapy

OMALIZUMAB (Anti-IgE)

Question 21

T/F

If you use a SABA twice a week; you do not have adequate control of your asthma.

Answer 21

True

SABA: Albuterol q4-6hrs
Xopenex (Levalbuterol) q8hrs

Question 22

If the SABA inhaler you Rx’d your patient is not being tolerated well; what else can you prescribe?

Answer 22

Ipratropium (Anticholinergic)

Question 23

What is Sampter’s Triad?

Answer 23

ASA sensitivity
Asthma
Nasal Polyps