Asthma Flashcards
This is characterized by airway narrowing and hyper responsiveness that leads to symptoms such as cough and wheezing?
Asthma
Airway inflammation leads to:
Acute bronchoconstriction
Airway edema
Mucous plug formation
Airway obstruction:
Leads to decreased ability to expel air
Results in hyperinflation
Often reversible with treatment
To diagnose asthma the clinician must:
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
Differential diagnoses for asthma in kids:
Airway foreign body, allergic rhinitis, aspergillosis, aspiration syndrome, bronchiectasis, bronchopulmonary dysplasia, CHF, GERD, and primary ciliary dyskinesia.
This is the amount of air exhaled in the 1sr second of forced expiration.
FEV1
This is the total volume of air exhaled during a forced expiratory effort.
FVC
This adjusts for FVC and <80% indicates obstruction.
FEV1/FVC ratio
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.
Peak expiratory flow rate
What is the peak expiratory flow rate based on?
HAG- height, age, and gender
What is the green zone for PEFR?
80-100% personal best = good control
Maintain or reduce medications
What is the yellow zone for PEFR?
50-80% of personal best= caution
Maintenance therapy needs to be increased or patient is having an exacerbation
What is the red zone for PEFR?
<50% of personal best = major airflow obstruction
If after treatment it remains below 50%, call 911
What objective findings are seen in asthma?
Lungs: prolonged expiratory phase. As asthma worsens, wheezing is in both inspiration and expiration.
CV: tachycardia
What is Step 1: intermittent asthma?
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
What is step 2: mild persistent asthma?
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
What is step 3: moderate persistent asthma?
Daily symptoms.
Daily use of SABA.
Nighttime symptoms more than 1 time per week but not nightly.
FEV1 >60% predicted but <80%
What is step 4: severe persistent asthma?
Continual symptoms.
Requires SABA several times/day.
Extremely limited physical activity.
Nighttime symptoms often nightly.
FEV1< 60%
How often should we follow up with asthma patients?
2-6 weeks while gaining control and then every 1-6 months
Treatment for step 1: intermittent asthma?
SABA
Treatment for step 2: mild persistent asthma?
Low dose ICS
Treatment for step 3: moderate persistent asthma?
Medium dose ICS or low dose ICS plus LABA
Treatment for step 4: severe persistent asthma?
Medium dose ICS plus LABA
Treatment for step 5 asthma?
High dose ICS plus LABA
Treatment for step 6 asthma?
High dose ICS plus LABA plus oral corticosteroids
Example of LABA:
Salmeterol (serevent)
Examples of ICS:
Fluticasone (Flovent)
Budesonide (pulmicort)
Examples of leukotriene modifiers:
Singuliar (montelukast)
Example of ICS plus LABA
Budesonide/formoterol (symbicort)
Mild asthma exacerbation in adults has:
Dyspnea with activity
Pulmonary function is 70% of predicted
Relief from SABA
Moderate asthma exacerbations in adults has:
Dyspnea that interferes with or limits usual activity
Peak flow is 40-69% predicted
Relief from frequently inhaled SABA
Treatment of moderate asthma exacerbations in adults:
Oral corticosteroids
Severe asthma exacerbations in adults have:
Dyspnea at rest and difficulty with regular conversation
Peak flow less than 40% of predicted
Partial relief from SABA
Treatment of severe asthma exacerbations in adults:
Oral or IV corticosteroids
May need hospitalization
Dosing is oral corticosteroids
Prednisone/prednisolone 1-2 mg/kg/day, max 40-80 mg/day outpatient
Preferred medication for asthma in pregnancy?
Albuterol- SABA
ICS- budesonide
Loratidine or ceftriaxone- if antihistamine needed to control allergies
Differential diagnoses for asthma in adults:
COPD, PE, CHF, mechanical obstruction (rumor), pulmonary infiltrates with eosinophils, medication induced cough, vocal cord dysfunction, laryngitis, GERD, OSA
