Asthma

Question 1

What are the symptoms of asthma? (name 3)

Answer 1

-Intermittent dyspnea
-Cough (persistent)
-Wheezing (sudden onset or persistent)
-Chest tightness
-Colds that take >10dys to resolve
-Apparent triggers (animals, tobacco smoke, perfume)
-Symptoms awaken patient from sleep
-Exertional symptoms
Seasonal (pollen, mold, viruses)
-Poor school performance & fatigue (sleep deprivation)

Question 2

Risk Factors for Asthma? (name 3)

Answer 2

• Socioeconomic status (poverty (esp in urban settings))
• Urban dwellers
• Food allergies (associated with intubations for asthma)
• Family history of asthma
• Atopy

Question 3

What are the three features of Atopy?

Answer 3

1. Allergic rhinitis (seasonal allergies)
2. Atopic dermatitis (eczema)
3. Asthma
   * Elevated IgE levels

Question 4

How can you distinguish asthma from COPD

Answer 4

On PFT spirometry, asthma is usually completely reversible with bronchodilator therapy whereas COPD is not.

Question 5

What are 3 Risk Factors for Fatal Asthma Attacks?

Answer 5

• Previous severe exacerbation (prior intubation or ICU stay)
• Hospitalization for asthma within prior year
• 3 or more ER visits for asthma in past year
• Use of more than one canister of SABA/month
• Difficulty perceiving asthma symptoms or severity of exacerbations
• History of poor adherence
• Illicit drug use or psychosocial problems
• Comorbidities such as cardiovascular or other chronic lung disease

Question 6

What are Extrapulmonary physical exam findings for asthma? (3)

Answer 6

• Pale, swollen nasal turbinates suggestive of allergic rhinitis
• Nasal polyps (in adults)
• Atopic dermatitis (eczema)– risk factor for asthma

Question 7

What should you use to monitor improvement/progression of asthma in a patient hospitalized with asthma exacerbation?

Answer 7

-Peak expiratory flow (Peak Flow Meter) daily

Question 8

What do you expect the FEV1/FVC ratio to be in asthma?

Answer 8

less than 0.7

Question 9

What do you expect the DLCO to be in asthma?

Answer 9

Normal

Question 10

If a child presents with persistent asthma symptoms, in addition to adding a maintenance medication, what should you pursue?

Answer 10

• Allergy skin testing to look for triggers

- Controlling environmental factors (triggers)

Question 11

What is the first line medication for mild persistent asthma in all populations?

Answer 11

Step 1: Short acting beta-agonist (SABA) prn (Albuterol inhaler)

Question 12

What maintenance medication should you add to a child with Persistent asthma if SABA PRN is not enough?

Answer 12

Step 2: Low dose inhaled glucocorticoid

Question 13

What medication should you add to inhaled glucocorticoid in a child if you need to escalate maintenance therapy?

Answer 13

Step 3: Long acting beta agonist (LABA) (Salmetrol) (or theophylline in kids age 5-11)

Question 14

What is the Treatment for Acute Asthma Exacerbation?

name 3

Answer 14

-Oxygen ( keep SaO2 >90% but <96%)
-Systemic glucocorticoid (methylprednisolone vs prednisone)
-Short acting bronchodilator (stacked nebs) (Albuterol ,
Add Ipratropium for severe flares in the ER, then resort back to only albuterol once admitted to the hospital)
-Magnesium (Intravenous) – for severe flares