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502 > Asthma > Flashcards

Asthma Flashcards

1
Q

This is characterized by airway narrowing and hyper responsiveness that leads to symptoms such as cough and wheezing?

A

Asthma

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2
Q

Airway inflammation leads to:

A

Acute bronchoconstriction
Airway edema
Mucous plug formation

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3
Q

Airway obstruction:

A

Leads to decreased ability to expel air
Results in hyperinflation
Often reversible with treatment

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4
Q

To diagnose asthma the clinician must:

A

Confirm episodes of airflow obstruction present such as wheeze, SOB, cough, cough at night, cough during/after exercise, sputum production and chest tightness.

Airflow obstruction are partially reversible

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5
Q

Differential diagnoses for asthma in kids:

A

Airway foreign body, allergic rhinitis, aspergillosis, aspiration syndrome, bronchiectasis, bronchopulmonary dysplasia, CHF, GERD, and primary ciliary dyskinesia.

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6
Q

This is the amount of air exhaled in the 1sr second of forced expiration.

A

FEV1

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7
Q

This is the total volume of air exhaled during a forced expiratory effort.

A

FVC

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8
Q

This adjusts for FVC and <80% indicates obstruction.

A

FEV1/FVC ratio

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9
Q

This measures effectiveness of treatment, worsening symptoms, and exacerbations. During expiration, patient is instructed to blow hard using the spirometer (3 times). The highest value is recorded as the patients personal best.

A

Peak expiratory flow rate

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10
Q

What is the peak expiratory flow rate based on?

A

HAG- height, age, and gender

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11
Q

What is the green zone for PEFR?

A

80-100% personal best = good control

Maintain or reduce medications

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12
Q

What is the yellow zone for PEFR?

A

50-80% of personal best= caution

Maintenance therapy needs to be increased or patient is having an exacerbation

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13
Q

What is the red zone for PEFR?

A

<50% of personal best = major airflow obstruction

If after treatment it remains below 50%, call 911

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14
Q

What objective findings are seen in asthma?

A

Lungs: prolonged expiratory phase. As asthma worsens, wheezing is in both inspiration and expiration.

CV: tachycardia

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15
Q

What is Step 1: intermittent asthma?

A

Symptoms 2 times or less/week

SABA 2 times or less/week

No interference with physical activity

Nighttime symptoms 2 times or less/ month.

FEV1 >80% predicted

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16
Q

What is step 2: mild persistent asthma?

A

Symptoms more than 2 times per week but less than 1 time per day.

Requires SABA more than 2 times a day but not daily.

Nighttime symptoms 3-4 times a month.

FEV1 >80% predicted

17
Q

What is step 3: moderate persistent asthma?

A

Daily symptoms.

Daily use of SABA.

Nighttime symptoms more than 1 time per week but not nightly.

FEV1 >60% predicted but <80%

18
Q

What is step 4: severe persistent asthma?

A

Continual symptoms.

Requires SABA several times/day.

Extremely limited physical activity.

Nighttime symptoms often nightly.

FEV1< 60%

19
Q

How often should we follow up with asthma patients?

A

2-6 weeks while gaining control and then every 1-6 months

20
Q

Treatment for step 1: intermittent asthma?

A

SABA

21
Q

Treatment for step 2: mild persistent asthma?

A

Low dose ICS

22
Q

Treatment for step 3: moderate persistent asthma?

A

Medium dose ICS or low dose ICS plus LABA

23
Q

Treatment for step 4: severe persistent asthma?

A

Medium dose ICS plus LABA

24
Q

Treatment for step 5 asthma?

A

High dose ICS plus LABA

25
Q

Treatment for step 6 asthma?

A

High dose ICS plus LABA plus oral corticosteroids

26
Q

Example of LABA:

A

Salmeterol (serevent)

27
Q

Examples of ICS:

A

Fluticasone (Flovent)

Budesonide (pulmicort)

28
Q

Examples of leukotriene modifiers:

A

Singuliar (montelukast)

29
Q

Example of ICS plus LABA

A

Budesonide/formoterol (symbicort)

30
Q

Mild asthma exacerbation in adults has:

A

Dyspnea with activity

Pulmonary function is 70% of predicted

Relief from SABA

31
Q

Moderate asthma exacerbations in adults has:

A

Dyspnea that interferes with or limits usual activity

Peak flow is 40-69% predicted

Relief from frequently inhaled SABA

32
Q

Treatment of moderate asthma exacerbations in adults:

A

Oral corticosteroids

33
Q

Severe asthma exacerbations in adults have:

A

Dyspnea at rest and difficulty with regular conversation

Peak flow less than 40% of predicted

Partial relief from SABA

34
Q

Treatment of severe asthma exacerbations in adults:

A

Oral or IV corticosteroids

May need hospitalization

35
Q

Dosing is oral corticosteroids

A

Prednisone/prednisolone 1-2 mg/kg/day, max 40-80 mg/day outpatient

36
Q

Preferred medication for asthma in pregnancy?

A

Albuterol- SABA

ICS- budesonide

Loratidine or ceftriaxone- if antihistamine needed to control allergies

37
Q

Differential diagnoses for asthma in adults:

A

COPD, PE, CHF, mechanical obstruction (rumor), pulmonary infiltrates with eosinophils, medication induced cough, vocal cord dysfunction, laryngitis, GERD, OSA

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