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NURS 503 > Asthma and COPD > Flashcards

Asthma and COPD Flashcards

1
Q

What is asthma (pathophysiology)?

A

Chronic reversible inflammatory disorder of the airways

  • Increased responsiveness of tracheobronchial tree to stimuli → episode reversible narrowing and inflammation of airways
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2
Q

What are the clinical hallmarks of asthma?

A
  • Episodic wheezing
    • Breathlessness, anxiety
  • Dyspnea
  • Cough (most common symptom)
  • Sputum production
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3
Q

True/false: Asthma is commonly diagnosed before 12 months of age

A

False - rarely diagnosed before 12 months because of high rates of viral bronchitis

  • May be diagnosed with bronchiolitis
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4
Q

What is exercise-induced asthma?

A

Airway narrowing during or 5-10 minutes after vigorous exercise

  • Typically resolves within 1-4 hours
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5
Q

What medications should patients with exercise induced asthma use if they exercise daily?

A
  • Rescue inhaler
  • Add ICS
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6
Q

What are the different types of asthma?

A
  • Exercise induced
  • Occupational/environment induced
  • Allergen induced
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7
Q

What are the four classifications of asthma severity?

A
  • Intermittent
  • Mild persistent
  • Moderate persistent
  • Severe persistent
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8
Q

Symptoms associated with intermittent asthma

A
  • Symptoms occur 2x or less per week
  • Asymptomatic and normal PEF between exacerbations
  • Requires SABA 2 days/week
  • Exacerbations are brief
  • No interference with normal activity
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9
Q

How often do nighttime symptoms occur with intermittent asthma?

A

2x or less per month

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10
Q

Symptoms associated with mild persistent asthma

A
  • Symptoms occur >2x/week but <1x/day
  • Requires SABA >2 days/week but not more than 1/day
  • Exacerbations may affect activity (minor)
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11
Q

How often do nighttime symptoms occur with mild persistent asthma?

A

3-4x/month

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12
Q

Symptoms associated with moderate persistent asthma

A
  • Daily symptoms
  • Daily use of inhaled SABA
  • Some limitation
  • Exacerbations affect activity, 2x or >/week, may last days
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13
Q

How often do nighttime symptoms occur with moderate persistent asthma?

A

>1/week but not nightly

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14
Q

Symptoms associated with severe persistent asthma

A
  • Continual symptoms
  • Requires SABA several times/day
  • Extremely limited physical activity
  • Frequent exacerbations
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15
Q

How often do nighttime symptoms occur with severe persistent asthma?

A

Often, 7x/week

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16
Q

How does asthma classification in severity differ between adults and pediatrics?

A

Similar classification, however poorly controlled asthma (mild, moderate, severe persistent) requires a step up in medication

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17
Q

Pediatric asthma physical exam findings

  • Mild
A
  • Wheezing at the end of expiration or no wheezing
  • No or minimal intercostal retractions along posterior axillary line
  • Slight prolongation of expiratory phase
  • Normal aeration in all lung fields
  • Can talk in sentences
  • O2 saturation >92%
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18
Q

Pediatric asthma physical exam findings

  • Moderate
A
  • Wheezing throughout expiration
  • Intercostal retractions
  • Prolonged expiratory phase
  • Decreased breath sounds at the base
  • O2 saturation >92%
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19
Q

Pediatric asthma physical exam findings

  • Severe
A
  • Use of accessory muscles plus lower rib and suprasternal retractions
  • Nasal flaring
  • Inspiratory and expiratory wheezing or no wheezing heard with poor air exchange
  • Suprasternal retractions with abdominal breathing
  • Decreased breath sounds throughout base
  • O2 saturation <92%
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20
Q

How would the provider manage a patient with chronic asthma?

A
  • Reduce environmental/allergen exposures
  • Treat rhinitis, sinusitis, GERD
  • Yearly flu vaccine
  • Medications: anticholinergics, cromolyn sodium, leukotriene modifiers, omalizumab
  • Regular follow up with PCP after ED care
  • Education (asthma action plan)
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21
Q

True/false: The severity of asthma attacks will determine the management approach

A

True - response to initial treatment determines subsequent treatment

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22
Q

When are antibiotics warranted for patients with asthma?

A
  • Fever
  • PNA
  • Bacterial sinusitis
  • Purulent sputum
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23
Q

What should the provider do if PEF values are 50-79% of personal best (asthma management)?

A
  • Patient requires quick relief medication
  • Depending on response to treatment, contact with pulmonologist may be indicated
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24
Q

What should the provider do if a patient has a PEF value <50% (asthma management)?

A

Need for immediate medical care

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25
Q

What are signs and symptoms of a serious asthma exacerbation?

A
  • Marked breathlessness
  • Inability to speak more than short phrases
  • Use of accessory muscles
  • Drowsiness
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26
Q

What is initial treatment for an asthma exacerbation?

A
  • Inhaled SABA (rescue inhaler)
    • Up to two treatments 20 minutes apart, 2-6 puffs by MDI, nebulizer
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27
Q

What is considered a good response to initial treatment of an asthma exacerbation? What further management is warranted at this time?

A
  • No wheezing or dyspnea, PEF >80% (after rescue inhaler use)
  • Contact PCP for follow up
  • Continue inhaled SABA every 3-4 hours for 24-48 hours
  • Consider short course of oral systemic corticosteroid
28
Q

What is considered an incomplete response to initial treatment of an asthma exacerbation? What further management can the provider do?

A
  • Persistent wheezing and dyspnea (tachypnea), PEF 50-79%
  • Add oral systemic corticosteroid
  • Continue inhaled SABA
  • Same day referral to PCP for further instruction
29
Q

What is considered a poor response to initial treatment of an asthma exacerbation? What further management should be done by the provider?

A
  • Marked wheezing and dyspnea, PEF <50%
  • Add oral systemic corticosteroid
  • Repeat inhaled SABA immediately
  • If distress is severe and non responsive to initial treatment: call PCP and head to ED
30
Q

What important information should be gathered in health history for patients with asthma?

A
  • Family history of asthma/atopy
  • Conditions associated with asthma → GERD, sinusitis, chronic OM
  • Chest tightness/dyspnea
  • Cough/wheezing
  • Seasonal or continuous symptoms
  • Recurrent “bronchitis” symptoms or PNA
  • Precipitation of symptoms
31
Q

Physical examination findings for asthma

A
  • Wheeze
  • Cough
  • Prolonged expiratory phase
  • Diminished breath sounds
  • Increased work of breathing/signs of distress
  • VS
  • Cyanosis
32
Q

True/false: Asthma is a diagnosis of exclusion

A

True - must include the following…

  • Episodic symptoms of airflow obstruction (wheeze, cough, SOB)
  • Evidence that airflow obstruction is at least partially reversible (trial of bronchodilator)
  • Exclusion of other conditions
33
Q

Diagnostic tests for asthma

A
  • Spirometry
    • Done in patients 5 years or older
    • PEFR and FEV1
  • Peak flow meters
    • Used to monitor symptoms
34
Q

When should spirometry be used for asthma diagnosis?

A

Recommended at the time of initial assessment, after treatment is initiated and symptoms and PEF have been stabilized, and at least every 1-2 years

35
Q

True/false: Peak flow monitoring helps individuals to follow the course of their disease, predict exacerbations, identify triggers, assess response to treatment

A

True - should be used as the basis for an asthma action plan

36
Q

How would a patient determine their personal best PEF with peak flow monitoring?

A

Can be estimated after a 2-3 week period

  • PEF is recorded at least once/day in early afternoon when asthma is well controlled
37
Q

What are the cut offs for peak flow meter zones (green, yellow, red)?

A

Green → >80% (90% for patients who decompensate quickly)

Yellow → 50-80% (can be 60-80%)

Red → <50% (or 60%)

38
Q

Management considerations for yellow zone (50-80%) readings on peak flow meter

A
  • Continue with green zone medication and add quick relief medication
  • Temporary increase in medication dose or frequency
    • Increase bronchodilator therapy, increase or add corticosteroid, add short course of oral corticosteroid
39
Q

Yellow zone (peak flow meter) signs

A
  • First signs of a cold
  • Exposure to known trigger
  • Cough
  • Mild wheeze
  • Tight chest
  • Coughing at night
40
Q

Red zone (peak flow meter) management

A
  • Immediate use of inhaled rescue bronchodilator
  • Start or increase oral corticosteroid therapy
  • If symptoms persist, call 911 or go to ED
41
Q

True/false: If asthma has been well controlled for 6 months, can “step down” in management

A

False - if well controlled for 3 months, can “step down”

42
Q

What are some forms of reliever medications for asthma?

A

All patients need a reliever medication (bronchodilator)

  • Short acting beta agonist bronchodilator (SABA)
  • Low dose ICS/formoterol
  • Short acting anticholinergic
43
Q

Examples of controller medications used for asthma control

A
  • Inhaled ICS and long acting beta agonist bronchodilator combinations (ICS/LABA)
  • Long acting anticholinergic
  • Systemic corticosteroid
44
Q

True/false: If a patient requires a rescue inhaler 4x/week or more, they will need controller medication

A

False - if using rescue inhaler 2x/week or more, will need controller medication

45
Q

Stepwise approach to asthma management

  • Step 1
A

Reliever medication

  • As needed short acting beta agonist (SABA) for relief
46
Q

Stepwise approach to asthma management

  • Step 2 (mild)
A
  • Reliever medication: as needed SABA
  • Preferred controller medication: low dose ICS
47
Q

Stepwise approach to asthma management

  • Step 3
A
  • Reliever medication: as needed SABA or low dose ICS/formoterol
  • Preferred controller medication: low dose ICS/LABA
48
Q

Stepwise approach to asthma management

  • Step 4
A
  • Reliever medication: as needed SABA or low dose ICS/formoterol
  • Preferred controller medication: medium high dose ICS/LABA
49
Q

Stepwise approach to asthma management

  • Step 5
A

Pulmonologist consultation

50
Q

When are follow up visits warranted for patients with asthma?

A
  • 1-3 months after starting treatment then every 3-12 months afterwards
  • If pregnant, follow up every 4-6 weeks
51
Q

When is a referral to a pulmonologist warranted for patients with asthma?

A
  • Diagnosis of asthma-related hospitalization
  • Poorly controlled asthma (e.g. frequent missed days of work and/or school)
  • Unresponsiveness to therapy
  • Second opinion
  • Periodic patient evaluation
52
Q

What is COPD?

A
  • Preventable and treatable disease characterized by airflow limitation
  • Progressive, not fully reversible
  • Predominately a smokers disease
53
Q

COPD is a term used to describe two related lung disease. What are they?

A
  • Chronic bronchitis
  • Emphysema
54
Q

What is the difference between chronic bronchitis and emphysema?

A

Chronic bronchitis - frequent cough with mucus

Emphysema - SOB

55
Q

When in the lifespan does COPD typically present?

A

Usual onset in midlife and associated with long history of smoking

  • Slow progressing symptoms
56
Q

COPD clinical presentation (symptoms)

A
  • Dyspnea on exertion
    • Persistent and progressive
    • Worse with exercise
  • Cough
  • Sputum production
57
Q

COPD physical examination findings

A

Suspected based on history and examination, but can be confirmed physiologically with simple spirometry

  • Skin → tobacco stains on fingers, clubbing
  • Pulmonary → inspiratory crackles, hyperinflation, forward sitting posture
  • Cardiac → RVH (cor pulmonale)
58
Q

Gold standard diagnostic test for COPD

A

Spirometry

  • Forced expiratory time
  • FEV1/FVC <0.70 (or <70%)
  • FEV1 <80%
59
Q

Other diagnostic tests used to diagnose COPD (other than spirometry)

A
  • Pulse oximetry
  • COPD assessment test
  • Chest x-ray
  • Hct and hbg
  • Blood gas measurements (if O2 sat <92%)
  • Alpha-1 antitrypsin deficiency
  • Biomarkers
  • EKG (cor pulmonale)
60
Q

What medication class should not be prescribed to patients with asthma or COPD?

A

Beta blockers

61
Q

COPD management considerations

A
  • Encourage smoking cessation
  • Oxygen therapy
  • Pulmonary rehabilitation
  • Exercise training
  • Psychological support
  • Nutrition → small frequent meals
  • Flu and pneumococcal vaccines
  • Palliative care (if end stage)
62
Q

Pharmacotherapy management for patients with COPD

A
  • Inhaled bronchodilators to relieve bronchospasm
  • Methylxanthine therapy to enhance bronchodilator therapy
  • Corticosteroids to reduce inflammation
  • Antibiotics for infection
63
Q

COPD exacerbation medication management

  • Mild
A

SABA prn

64
Q

COPD exacerbation medication management

  • Moderate
A
  • SABA
  • Oral corticosteroid (prednisone)
  • Antibiotic (if indicated)
65
Q

COPD exacerbation medication management

  • Severe
A

Go to ED for hospitalization

NURS 503 (10 decks)

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