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Final Review > ASTHMA > Flashcards

ASTHMA Flashcards

1
Q

What is the antibody associated with asthma

A

IgE Antibody

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2
Q

General Risk Factors for Asthma

A

Obesity

Family history

Indoor/Outdoor pollutants

Dust, Spray Paint, Fumes, etc.

Viral Infections

Sinitis, Rhitis (Hay Fever), gastroesophageal reflux (GERD)

Exercise-Induced Asthma

Drugs, Food additives, and food preservatives

Sleep (nocturnal asthma)

Emotional stress

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3
Q

Occupational Risk Factors

A

triggered through occupational sensitizers

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4
Q

Asthma and Gender Epidemiology

A

Among young children, asthma is about two times more prevalent in boys than girls

Male children also have a higher incident of asthma in infections

After puberty, however, asthma is more common in girls

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5
Q

Perimenstral asthma

A

Also known as catamenial asthma

Asthma in relation to your period

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6
Q

Extrinsic Asthma

A

Also known as allergic or atropic

Extrinsic asthma is an immediate (Type 1) anaphylactic hypersensitive reactive

Extrinsic asthma is family related and usually appears in children and adults younger than 30 years old

Will often disappear after puberty

Because extrinsic asthma is associated with an antigen-antibody indicuded bronchospasm, a immunologic mechanism plays a important role

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7
Q

INTRINSIC ASTHMA

A

NONALLERGIC/NONATOPIC OR TYPE TWO ASTHMA

An asthma episode cannot be directly linked to a specific antigen or extrinsic factor

Onset usually occurs after the age of 40 years

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8
Q

Anatomical Alterations Due to Asthma

A

Smooth muscle constriction of bronchial airways (bronchospasm)

Bronchial wall inflammation

Excessive production of thick, whitish, bronchial secretions

Mucus plugging

  • Hyperplasia of smooth muscle (remodleing)
  • Bronchial reactvity and chronic bronchial inflammation

Hyperinflation of alveoli (air-trapping)

In severe cases, atelectasis caused by mucus plugging

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9
Q

Diagnosis of Asthma-Wheezing

A

WHEEZING-History of the following

  • Cough, worse particularly at night
  • Recurrent wheeze
  • Recurrent difficultly breathing
  • Recurrent chest tightness

Symptoms occur or worsen at night, awakening the patient

Symptoms occur or worsen in a seasonal pattern

The patient also has eczema, hay fever, or a family history of asthma or atopic disease

Symptoms occur or worsen in the presence of triggers

Symptoms respond to appropriate anti-asthma therapy

Patient’s colds “go to the chest” or take more than 10 days to clear up

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10
Q

TESTS USED TO DIAGNOSE ASTHMA

A

Spirometry

Peak Expiratory Flow

Responsiveness to Metacholine, histamine, mannitol, or exercise challenge

Positive skin test with allergens or measurement of specific IgE in serum

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11
Q

INTERMITTENT ASTHMA

A

Symptons will occue less than once a week, with brief exacerbations.

Nocturnal symptons are less than twice a month

FEV1 or PEF 80% of predicted

PEF or FEV1 variability < 20%

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12
Q

MILD PERSISTENT ASTHMA

A

Symptoms more than once a week but less than once a day

Exacerbations may affect activity and sleep

Nocturnal symptoms more than twice a month

FEV1 or PEF 80% of predicted

PEF or FEV1 variability < 20-30%

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13
Q

MODERATE PERSISTENT ASTHMA

A

Symptoms daily

Exacerbations may affect activity and sleep

Nocturnal symptoms more than once a week

Daily use of inhaled short-acting 2-agonist

FEV1 or PEF 60-80% of predicted

PEF or FEV1 variability > 30%

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14
Q

SEVERE PERSISTENT ASTHMA

A

Symptoms daily

Frequent nocturnal symptoms

Limitations of physical activities

FEV1 or PEF 60% of predicted

PEF or FEV1 variability > 30%

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15
Q

Vital Signs from an Asthma Exasterbation

A

Increased

  • RR
  • HR
  • BP
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16
Q

PHYSICAL EXMINATION OF AN ASTHMA EXACERBATION

A

Use of accessory muscles of inspiration

Use of accessory muscle of expiration

Pursed lip breathing

Substernal intercostal retractions

Increased anteroposterior chest diameter (Barrel chest)

Cyanosis

Cough and sputum production

Pulsus Paradoxus (Decreased blood pressure during inspiration and Increased blood pressure during expiration)

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17
Q

Breathing Assessment in Asthma Exasterbation

A

Expiratory prolongation (I:E > 1:3)

Decreased tactile and vocal fremitus

Hyper-resonate percussion note

Diminished breath sounds

Diminished heart sounds

Wheezing and rhonchi

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18
Q

Forced Expiration Flow Rate Finding in a Moderate to Severe Asthmatic Episode

A

Obstructive Lung Pathophysiology

Everything will Decrease

FVC

Decreased

FEV1

Decreased

FEV1/FVC Ratio

Decreased

FEF 25-75%

Decreased

FEF50%

Decreased

FEF200-1200

Decreased

PEFR

Decreased

MVV

Decreased

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19
Q

Forced Expiration Flow Rate Finding in a Moderate to Severe Asthmatic Episode-FVC

A

Normal is 4.8 L

Decreased

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20
Q

Forced Expiration Flow Rate Finding in a Moderate to Severe Asthmatic Episode-FEV1

A

FEV1 normal is 4.2 L

Decreased

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21
Q

Forced Expiration Flow Rate Finding in a Moderate to Severe Asthmatic Episode-FEV1/FVC Ratio

A

FEV1/FVC Ratio normal is > or equal to 70%

Decreased

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22
Q

Forced Expiration Flow Rate Finding in a Moderate to Severe Asthmatic Episode-FEF 25-75%

A

FEF 25-75% is 4.5 L/sec

Decreased

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23
Q

Moderate to Severe Asthmatic Episode-FEF50%

A

FEF50% normal is 6.5 L/sec

Decreased

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24
Q

Moderate to Severe Asthmatic Episode-FEF200-1200

A

FEF200-1200 normal is 8.5 L/sec

Decreased

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25
Q

Moderate to Severe Asthmatic Episode-PEFR

A

PEFR normal is 9.5 L/sec

Decreased

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26
Q

Moderate to Severe Asthmatic Episode-MVV

A

MVV normal is 160 L/min

Decreased

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27
Q

Moderate to Severe Asthmatic Episode-Vt

A

Normal or increased

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28
Q

Moderate to Severe Asthmatic Episode-IRV

A

IRV

Normal or decreased

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29
Q

Moderate to Severe Asthmatic Episode-ERV

A

Normal or decreased

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30
Q

Moderate to Severe Asthmatic Episode-RV

A

Increased

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31
Q

Moderate to Severe Asthmatic Episode-VC

A

Decreased

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32
Q

Moderate to Severe Asthmatic Episode-IC

A

Normal or decreased

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33
Q

Moderate to Severe Asthmatic Episode-FRC

A

Increased

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34
Q

Moderate to Severe Asthmatic Episode-TLC

A

Normal or increase

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35
Q

Moderate to Severe Asthmatic Episode-RV/TLC Ratio

A

Normal or increased

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36
Q

Arterial Blood Gases in Asthma

A

An ABG will initially show acute alveolar hyperinflation with hypoxemia, but may show hypercarbia in status asthmaticus

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37
Q

What will the arterial blood gas show in a mild to severe asthma attack

A

Acute Alveolar Hyperventilation with Hypoxemia (Acute Respiratory Alkalosis)

The PaCO2 will sharply go up and PaO2 will sharply go down because the muscles become over fatigues and can no longer compensate so they hypoventilate

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38
Q

Chest Radiograph

A

Increased antero-posterior diameter (barrel chest)

Translucent (dark) lung fields

Depressed or flattened diaphragms

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39
Q

Sputum Examination

A

Eosinophils

Charcot-Leyden Crystals: Product of the breakdown of eosinophils combined with lysophospholipase

Cast of muscus from small airways (Kirschman spirals)

IgE Levels-Elevated in extrinsic asthma

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40
Q

Moderate to Severe Asthma Attack Qs-Qt

A

This is the shunt %

Normal is <10

In asthma moderate to severe stages will increases

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41
Q

Moderate to Severe Asthma Attack DO2

A

This is the delivery of O2

Normal is 1000 mL

In asthma moderate to severe stages will decrease

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42
Q

Moderate to Severe Asthma Attack VO2

A

This is the O2 consumption

Normal is 250 mL/min

In asthma moderate to severe stages will be normal

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43
Q

Moderate to Severe Asthma Attack C(a-v)O2

A

This is the Content A-V delta

Normal is 5 vol%

In asthma moderate to severe stages is normal

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44
Q

Moderate to Severe Asthma Attack O2ER

A

This is the extraction ratio

Normal is 25%

In asthma moderate to severe stages will increases

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45
Q

Moderate to Severe Asthma Attack SvO2

A

This is the venous saturation

Normal is 75%

In asthma moderate to severe stages will decrease

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46
Q

GINA’S FIVE COMPONENETS OF ASTHMA CARE

A

Identify and Reduce Exposure to Risk Factors

Assess, treat, and monitor asthma

Manage Asthma Exacerbations

Special Considerations

Treatment Protocols

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47
Q

DEVELOP THE PATIENT/DOCTOR PARTNERSHIP

A

Avoid risk factors

Take medications correctly

Understand the difference between “controller medications” and “reliever” medications (also called rescue medications)

Monitor the status using symptoms and, if relevant, PEFR

Recognize signs that asthma is worsening and take action

Seek medical help as appropriate

Look at your asthma action plan and for indications if status if getting worse

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48
Q

Asthma Management Continuum

A

From controlls to uncontrolled

  1. Confirm Diagnosis
  2. Enviromental control, education, and action plan
  3. Fast acting bronchodilator on demand
  4. Inhaled Corticosteroid (ICS)-2nd Line Leukotriene Recptor Anatagonist (LTRA)
  5. Add LABA if older than 12 but if 6-11 increase ICS
  6. Add LTRA if older than 12 but if 6-11 add LABA or LTRA
  7. Anti IgE
  8. Prednisone
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49
Q

Asthma Exacerbation Definition

A

Asthma exacerbation is defined as a progressive increase in shortness of breath, cough, wheezing, or chest tightness, or any combination of these symptoms

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50
Q

Corticosteroids (Inhaled Corticosteroids=ICS)

A

Maintanence and control of chronic asthma through the suppression of activated inflamatory genes in the airway epithelial cells

First line therapy in mild, moderate and severe asthma as it is considered to be the most effective long term therapy

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51
Q

ICS in Asthma versis COPD

A

It is considered to be a first line of defense in asthma but not for COPD

Not considered first line therapy for treatment of COPD (used in combination: ICS/LABA). This is because COPD has a different pattern of inflammatory cells in comparison to asthma (neutrophils are seen in COPD). Oral and ICS do not influence the inflammatory changes driven by neutrophils.

Patients with stable COPD should not be given systemic steroids.

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52
Q

Antiallergic Agents

A

Mediator antagonists (Nonsteroidal)

Agents that are prophylactic, antiallergic, antiasthmatic

Act as antagonists to mediators of inflammation

These are not steroids

Includes Anti-Leukotrienes like Singulair

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53
Q

Leukotriene Inhibitor

(LTRA’s: Leukotriene Receptor Antagonists)

A

Zafirlukast – ACCOLATE

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54
Q

Zafirlukast (ACCOLATE)

Indications

A

For the prophylaxis and chronic treatment of asthma

Effective in preventing bronchoconstriction and other asthmatic airway responses in allergen, exercise and cold air challenges

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55
Q

Zafirlukast (ACCOLATE)

Mode of Action

A

Selectively competes for leukotriene receptor LTD4 and LTE4 sites, preventing the inflammatory response of airway contractility, vascular permeability and mucus secretion.

Inhibits asthma reactions induced by exercise, cold air, allergen and aspirin

Leukotrienes are more potent than histamines in causing bronchospasm.

They are also potent stimulants of mucus secretion

Oral Vs. Inhaled

  • Oral will inhibit early and late phase asthma and cause modest bronchodilation
  • Inhaled format inhibits early phase only
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56
Q

Montelukast-Singular

Indication for Use

A

For the prophylaxis and chronic treatment of asthma

Effective in preventing bronchoconstriction and other asthmatic airway responses in allergen, exercise and cold air challenges

Approved for use in children as young as 6 months

Useful for mild-moderate asthma,

Also approved for allergic rhinitis

57
Q

Montelukast-Singular

Mode of Action

A

Selectively competes for leukotriene receptor LTC4, LTD4 and LTE4 sites, preventing the inflammatory response of airway contractility, vascular permeability and mucus secretion.

Leukotrienes are more potent than histamines in causing bronchospasm.

Also inhibits both early and late phase bronchoconstriction

58
Q

Montelukast-Singular

Side Effects

A

Laryngitis, pharyngitis, cough

Nausea, diarrhea, pain

Otitis, sinusitis

59
Q

Zileuton – ZYFLO

Indication for Use

A

This drug is indicated for the prophylaxis and chronic treatment of asthma, and is approved for use in adults and children over 12 years of age

It is a controller not a reliever and has no use in an acute asthma attack

60
Q

Zileuton – ZYFLO

Mode of Action

A

Leukotriene receptor antagonist like Accolate.

Inhibits the formation of leukotrienes from arachidonic acid. By interrupting the synthesis of these biologically active leukotrienes their contribution to the inflammatory responses in asthma is effectively blocked

Inhibits the 5-LO enzyme which would otherwise catalyze the formation of leukotrienes from arachidonic acid

61
Q

Zileuton – ZYFLO

Hazards and Side Effects

A

Headache, neck pain

General pain

Abdominal pain

Loss of strength

Nausea, vomiting, constipation, flatulence

Liver enzyme elevations

Recommend monitoring liver enzymes during treatment – liver enzymes may decrease or return to normal during tx or after discontinuation

Contraindicated in patients with acute liver disease or with elevated liver enzymes

Taken at meals and at bedtime.

62
Q

BIOLOGICS (Anti Immunoglobulin E (Anti IgE)

A

Xolair – Omalizumab

An injectable Biologic used with Asthmatics with allergic components that are not well controlled with maximized conventional therapy. Biologic means made of animal or human protein – genetically engineered

It is an anti-IgE monoclonal antibody that inhibits the immunologic cascade by blocking IgE

Expensive treatment not covered by all drug programs

Symptoms are inadequately controlled with inhaled corticosteroids.

Xolair has been shown to significantly decrease the incidence of asthma exacerbations and improve control of asthma symptoms in these patients.

Safety and efficacy have not been established in other allergic conditions.

Anaphylaxis rare. However, can occur after first dose or 1 year into treatment therefore, pt. must be monitored appropriately following injection

63
Q

Omalizumab - Xolair

A

Indicated for the treatment of moderate to severe asthma in adults and peds (>12 years old) who have a positive skin test to aeroallergen

Patients must have S.Q injections every 2 or 4 weeks – comes in a 150 mg vial, dependent on the weight and serum IgE level of the patient

Issues: Anaphylaxis, expensive, requires an injection, duration of treatment

Anaphylaxis rare – can occur after the first dose or 1 year into tx,

Pharmacokinetics – after administration – absorbed slowly – peak effect in 7-8 days, excreted by the liver, half-life of aprox 26 days (may be weight related – increasing weight, increases clearance)

Not indicated for acute relief of SOB

Not a replacement for inhaled corticosteroids

Not optimal as monotherapy in persistent asthma

May allow reduction of high-dose ICS or allow for decreasing of ICS dos

May allow reduction in asthmatic rescue agents

64
Q

Beclomethasone Dipropiontae

A

Inhaled Corticosteroids

QVAR

65
Q

Triamcinolone Acetonide

A

Inhaled Corticosteroids

azmacortt

66
Q

Flunisolide

A

Inhaled Corticosteroids

Aerobid

AeroBid-M

67
Q

Fluticasone Propionate

A

Inhaled Corticosteriods

Flovent

HFA

Flovent

Diskus

68
Q

Ciclesonide

A

Inhaled Corticosteriods

Alvesco

69
Q

Budesonide

A

Inhaled Corticosteroid

Pulmicort

Turhuhaler

70
Q

Momestasone Furate

A

Inhaled Corticosteroid

Asmanex

Twisthaler

71
Q

Methylprednisolone

A

SYSTEMIC CORTICOSTEROIDS

Medrol

Solu-Medrol

72
Q

Hydrocortisone

A

SYSTEMIC CORTICOSTEROIDS

Solu-Cortef

73
Q

SALMETEROL

A

LONG-ACTING 2-AGENTS (LABA)

SEREVERT

74
Q

Formoterol

A

LONG-ACTING 2-AGENTS (LABA)

Foradil

75
Q

Arformoterol

A

LONG-ACTING 2-AGENTS (LABA)

Brovana

76
Q

Fluticasone/Sameterol

A

INHALED CORTICOSTEROIDS AND LABA

Advair Diskus

77
Q

Budesonide/Formoterol

A

INHALED CORTICOSTEROIDS AND LABA

Symbicort

78
Q

Cromolyn Sodium

A

MAST-CELL STABILIZING AGENTS

Intal

79
Q

Zafirlukast

A

LEUKOTRIENE INHIBITORS (ANTILEUKOTRIENES)

Accoclate

80
Q

Montelukast

A

LEUKOTRIENE INHIBITORS (ANTILEUKOTRIENES)

Singulair

81
Q

Aminophylline

A

XANTHINE DERIVATIVES

Aminophylline, Theo-Dur

82
Q

Asthma Rates

A

Asthma rates continue to increase in both sexes however self reported rates are higher in women than in men

83
Q

COPD vs. Asthma PFT

A

COPD FEV1/FVC >70% and FEV1 < 80% of predicted in response to bronchodilator therapy

If post bronchodilator therapy FEV1 increases > 0.4 L then the COPD pt. may also have underlying asthma and will benefit from a combined therapy of bronchodilators and inhaled steroids

84
Q

COPD vs. Asthma Lab Results

A

COPD-Increases in neutrophils and macrophages

Asthma-Increases in eosinophils inflammation

85
Q

COPD vs. Asthma Management

A

COPD-Non drug oriented that is more focused on rehab

Asthma-Drug oriented

86
Q

COPD vs Asthma-Age of Onset

A

COPD-> 40 yrs of age

Asthma- < 40 yrs of age

87
Q

COPD vs Asthma-Smoking history

A

More common in COPD

88
Q

COPD vs Asthma-Sputum Production

A

Asthma-Infrequent

COPD-Often

89
Q

COPD vs Asthma-Allergies

A

Asthma-Often

COPD-Infrequent

90
Q

COPD vs Asthma-Clinical Symptons

A

COPD-Presistent and Progressive

Asthma-Intermittent and Variable

91
Q

COPD vs Asthma-Disease Course

A

COPD-Progressively worsening

Asthma-Stable

92
Q

COPD vs Asthma-Airway Inflammation

A

COPD-Neutrophils

Asthma-Eosinophils

93
Q

COPD vs Asthma-Response to Inhaled Corticosteroids

A

COPD-Helful in patient with moderate to severe disease

Asthma-Essential

94
Q

COPD vs Asthma- Role of bronchodilator

A

COPD-Regular therapy

Asthma-Only use as needed

95
Q

COPD vs Asthma-Exercise

A

Asthma-Rarly used

COPD-Essential

96
Q

What does hyperractivity of the airways lead to?

A

Bronchoconstriction & bronchospasm, mucosal swelling, and increased production of thick tenacious mucus.

97
Q

What are signs, symptoms, and observations of asthma?

A

Increased respiratory rate, work of breathing, heart rate, cardiac output, and blood pressure. The patient may also have a prolonged (forceful) expiration and a decreased peak expiratory flow rate.

98
Q

What happens when mediators are released in asthma?

A

Bronchoconstriction, bronchospasm, pulmonary vasodilation, airway inflammation, and increased mucus production.

99
Q

What are some special medications used for asthma?

A

Luekotriene antagonist, Montelukast Sodium (Singulair).

100
Q

What are some prophylactic medications used for asthma?

A

Cromolyn (intal) and Nedocromil (tilade).

101
Q

When would you use Xolair (omalizumab) to treat asthma?

A

It can be used to treat patient that are 12 years of age and above. They must have a moderate to severe persistent asthma have asthma triggered by year-round allergens in the air, and continue to have asthma symptoms even though they are taking inhaled steroids.

102
Q

True or False: A methacholine challenge test can be used in the diagnoses of asthma.

A

True. A methacholine challenge test is performed to determine how reactive or responsive your lungs are to different asthma triggers in the environment. The test can help your doctor evaluate symptoms suggestive of asthma and help diagnose whether or not the patient has it.

103
Q

What is an allergen?

A

They affect only people allergic to a specific substance.

104
Q

What is an irritant?

A

The effect everyone if the dose is high enough.

105
Q

What are some examples of irritants?

A

Tobacco smoke, wood smoke, chemicals in the air, ozone, perfumes, household cleaners, cooking fumes, paints, and varnishes.

106
Q

What are some occupational irritants?

A

Vapors, dust, gases, and fumes.

107
Q

What are some other common causes of asthma?

A

Viral and sinus infections, exercise, reflux disease herd, medications (NSAIDS), beta blockers, and emotional anxiety.

108
Q

What are the types of medications that help with asthma symptoms?

A

Antihistamines, decongestants, anti-inflammatory agents, anti-leukotrienes, bronchodilators, and anticholinergics.

109
Q

What are the 3 types of medications that are used as anti-inflammatory agents?

A

Mast cell stabilizers, corticosteroids, and bronchodilators.

110
Q

What are the classes of bronchodilators available for asthma?

A

Beta-agonist bronchodilators, methylxanthines, and anticholinergics.

111
Q

What are methylxanthines?

A

PDE inhibitors such as theophylline, aminophylline, and theobromide.

112
Q

How do anticholinergics work?

A

They block the veal nerve in bronchoconstriction and can be used alone or along with bronchodilators. Some examples include Atrovent and Spiriva (tiotropium bromide). These are better for COPD rather than asthma.

113
Q

What are the 6 goals for the effective management of asthma?

A

(1) To prevent chronic and troublesome symptoms, (2) to maintain normal breathing, (3) to maintain normal activity levels including exercise, (4) to prevent recurrent asthma flare-ups, (5) to minimize the need for emergency room, and (6) to provide optimal medication therapy with no or minimal effort.

114
Q

What are the rules of 2 for asthma medications that tell you that your asthma is not under control?

A

You use a rescue inhaler more than 2 times a week, you awaken at night with asthma symptoms more than 2 times a month, you use more than 2 canisters a year of rescue medications (inhaler).

115
Q

What are quick-relief medications?

A

Short-acting beta-2 agonists, inhaled anticholinergics, short-acting theophylline, epinephrine/ adrenaline injection.

116
Q

What are examples of long-term asthma medications?

A

Corticosteroids, tablets or syrup steroids, mast cell stabilizers, long-acting beta-2 agonist, sustained-release tablets, sustained release methylxanthines, anti-leukotrienes.

117
Q

What is immunotherapy?

A

It’s a form of antigen extract to desensitize the patient to asthma triggers. It can help to reduce asthma symptoms, as well as the need for medications. It can also help reduce the risk of severe asthma attacks after future exposure to the allergen. It has been shown to possibly be as effective as inhaled steroids.

118
Q

If the PaCO2 rises drastically and suddenly during an asthma attack, what does that mean?

A

It likely means that the patient isn’t moving any air and may be going into respiratory failure. This is a very dangerous situation and may require intubation and mechanical ventilation.

119
Q

What will a PFT test show on an asthmatic?

A

Decreased airflow, low peak flows, and an increased residual volume. The FVC may be decreased due to air trapping, and the FEV1/FVC ratio is decreased.

120
Q

What happens to the systolic blood pressure during an asthma attack?

A

It will decrease during inspiration by 10-20 mmHg.

121
Q

Which WBC increases during an asthma attack?

A

Eosinophils.

122
Q

What is Pulsus Paradoxus?

A

It is an abnormally large decrease in the patient’s stroke volume, systolic blood pressure and pulse wave amplitude during inspiration.

123
Q

What is Asthma

A
  • Asthma is a condition in which a person’s airways become inflamed, narrow and swell, and produce extra mucus, which makes it difficult to breathe.
  • The disease is chronic, obstructive, inflammatory, and varies with different levels of severity.
  • There will be recurring episodes of paroxysmal dyspnea, wheezing on expiration and inspiration caused by constriction of the bronchi, coughing, and viscous mucoid bronchial secretions.
    • The episodes may be precipitated by inhalation of allergens or pollutants, infection, cold air, vigorous exercise, or emotional stress.
  • It’s essentially hyperreactivity of the airways
124
Q

Hyperreactivtiy in Asthma

A

During the course of inflammation bronchial hyperreactivity will occur

  • In comparison to healthy people the airways of patient with asthma react more sensitive to various stimuli
    • The consequence is paroxysmal and recurring obstruction in the airways
125
Q

Atopic Syndrome

A

Allergic type of asthma often exists in combination with other diseases pertaining to the atopic syndrome, such as allergic rhinitis or neurodermatitis.

126
Q

What Does All Extrinsic Asthma HAve in Common

A
  • They all have in common a polygenic predisposition for excessive production of IgE.
127
Q

Intrinsic Asthma Causes

A
  • Causes can include
    • Stress
    • Cold or dry air
    • Smoke
    • Noxious inhaled agents
    • GERD
    • Anxiety
    • Acetylsalicylic acid/NSAIDs
      • Analgesic Asthma Syndrome
    • Viruses
    • Infections.
128
Q

The two Types of asthma

A
  • Often, the two types cannot be rigorously distinguished especially when they occur in adult asthmatics. Only 30 % of patients suffer from a purely extrinsic or intrinsic asthma; the rest display hybrid forms of both types.
129
Q

Pathophysiology of Extrinsic Asthma

A
  • After a few minutes of coming into contact with a corresponding allergens IgE antibodies will appear
  • These antibodies will activate mast cells, which will release mediators such as leukotriene, prostaglandin, and histamine
    • Type 1 hypersensitivity reaction
  • These mediators will cause bronchospasm and attract inflammatory cells
    • The inflammatory cells will create long term chronic inflammation
130
Q

Pathophysiology of Intrinsic Asthma

A
  • The immunological process is similar to extrinsic asthma but without a triggering allergen, rather there is infectious agents (viruses) that can be triggering factors
131
Q

Classic Signs of Asthma

A
  • Shortness of breath
  • Expiratory stridor
  • Chronic cough
    • Mostly dry and in spasms (cough variant asthma)
  • Thoracic tightness
  • Symptoms respond to appropriate anti-asthma therapy
132
Q

What part of the airway is mainly involved in astham

A
  • Mainly involves the medium sized and small bronchi
133
Q

Spirometry for Asthma

A
  • Improvement in FEV1 >/= 12% and >/= 200 mL

% Improvement= [(Post FEV1-Pre FEV1)/ Pre FEV1] x 100

134
Q

Asthma and PFT

A
  • An essential part of diagnosis asthma is the PFT
  • In a PFT an obstruction with an increase in airway resistance can be observed
    • FEV1 is reduced
    • Given an approximately constant vital capacity, this yields a reduced Tiffeneau-Pinelli index: FEV1 / VC < 70 %.
  • A decisive factor in differential diagnosis (e.g. in comparison to COPD) is the reversibility of the obstruction, tested in a bronchodilator reversibility test
    • The FEV1 value improves significantly either directly after administration of inhaled bronchodilator medication (e.g., 400 μg salbutamol) or in case of a lack of response, after administration of inhaled glucocorticoids over 4 weeks.
  • If the pulmonary function testing does not show any abnormalities despite suspected asthma, a provocation test (methacholine challenge test) can confirm a diagnosis.
    • The patient inhales methacholine or histamine, and due to the hyperreactivity of the airways, this provokes bronchoconstriction, which leads to a reduced FEV1 value by least 20 % and a doubling of resistance.
    • The following inhalation of salbutamol dilates the bronchial tubes and normalization of the pulmonary function parameters should be achieved.
135
Q

ABG With Mild Asthma Attack

A
  • pH
    • Increased
  • PaCO2
    • Decreased
    • Due to hyperventilation
  • HCO3
    • Slightly Decreased or Normal
  • PaO2
    • Normal
136
Q

ABG With Moderate Asthma Attack

A

Acute Alveolar Hyperventilation with Hypoxemia (Acute Respiratory Alkalosis)

  • pH
    • Normal
  • PaCO2
    • Normal
  • HCO3
    • Normal
  • PaO2
    • Normal but starting to decrease
137
Q

ABG with Severe Asthma Attack

A

Acute Alveolar Hyperventilation with Hypoxemia (Acute Respiratory Alkalosis)

  • In severe asthma attacks, it will be a case of impending respiratory failure
  • pH
    • Decrease
  • PaCO2
    • Increase
  • HCO3
    • Decrease
  • PaO2
    • Severe Decrease
138
Q

Cardiac Asthma Differential diagnosis

A
  • Patients with left-sided heart failure who have developed a lung congestion with shortness of breath. Bilateral basal rales during auscultation of the lungs and a chest x-ray with signs of pulmonary congestion lead to the right diagnosis.

Final Review (27 decks)

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