Asthma & Bronchospastic Diseases

Question 1

True or false: Asthma is a chronic inflammatory disorder

Answer 1

True

Question 2

Asthma is underdiagnosed in what population?

Answer 2

Elderly

Question 3

What is the primary contributor to fatal asthma?

Answer 3

Airway remodeling

Question 4

What are some important preoperative considerations for the management of asthma patients?

Answer 4

Asthma related history: medicine**, triggers, hospitalizations

Other history: GERD, smoking, URIs etc

Question 5

What type of test is used to assess occult bronchospasm and measure lung function?

Answer 5

Spirometry

Question 6

Which lung volume Is the most reproducible PFT parameter?

Answer 6

FEV

Question 7

What test is a better indicator of small airway involvement and is effort dependent?

Answer 7

FEF 25-75% spirometry

Question 8

What will the arterial blood gas results look like in a patient with severe asthma?

Answer 8

Hypercarbia and hypoxia are indicative of severe disease

Question 9

List a few of the precipitating causes of asthma

Answer 9

Allergens
Pharmacologic agents
Infections
Exercise
Emotional stress

Question 10

30 to 80% of asthma patients also have what other exacerbating disease?

Answer 10

GERD

Question 11

How does GERD Cause asthma or bronchospasms?

Answer 11

Aspiration of refluxed gastric contents

Question 12

What are some common symptoms associated with aspirin induced asthma?

Answer 12

rhinitis and nasal polyps (70-80%)

Question 13

The usage of what common drug during pregnancy is associated with childhood asthma?

Answer 13

Acetaminophen

Question 14

25% of asthmatics smoke. why is this important?

Answer 14

They’re at increased risk of laryngeal and bronchial reactivity and they have a reduced response to corticosteroids

Question 15

How long before surgery do you have to stop smoking before there will be decreased airway reactivity?

Answer 15

7 days

Question 16

How long before surgery do you have to stop smoking before they will be reduced post-operative respiratory complications?

Answer 16

4 weeks

Question 17

Chronic use of what illegal substance can cause hypersensitivity pneumonitis?

Answer 17

Crack

Question 18

Isolated use of what illegal substance is a bronchodilator?

Answer 18

THC, marijuana, Mary Jane, weed, pot, reefer. Call it what you will. Shit stinks.

Question 19

What additives in wine can trigger bronchospasm?

Answer 19

Sulfites

Question 20

What is the most common cause of an upper respiratory infection?

Answer 20

Viral infection

Question 21

What impact do URIs have on asthmatics?

Answer 21

Asthmatics suffer greater increase in airway reactivity

Question 22

The risk of asthma increases by what percent per unit BMI?

Answer 22

7%

Question 23

What are some important anesthetic considerations for patients with asthma?

Answer 23

Additional albuterol
Anti-cholinergic
Corticosteroids
Benzodiazepines
Avoid histamine releasing agents (morphine)
Treat GERD
Judicious use of NSAIDs

Question 24

If feasible, what type of anesthesia is ideal for asthmatics?

Answer 24

Regional

Question 25

Which induction agent depresses airway reflexes effectively?

Answer 25

Propofol

Question 26

Which induction agent can depress neural airway reflexes but can also increase secretions?

Answer 26

Ketamine

Question 27

True or false: There is no conclusive evidence that IV lidocaine alone protects against intubation induced bronchospasm

Answer 27

True

Question 28

All volatile anesthetics have what effect on airways

Answer 28

Bronchodilators

Question 29

Which volatile anesthetic elicits the least amount of airway reactivity at lower doses?

Answer 29

Sevoflurane

Question 30

Why should you be judicious when using cholinesterase inhibitors?

Answer 30

They can increase secretions and promote bronchospasm

Question 31

What is the most common cause of perioperative bronchospasm?

Answer 31

In adequate depth of anesthesia

Question 32

How is a Perioperative bronchospasm treated?

Answer 32

Confirm diagnosis Deepen anesthesia Adjust ventilation Pharmacologic therapy

Question 33

What type of pharmacologic therapy is used in the treatment of chronic asthma?

Answer 33

Corticosteroids

Question 34

What type of pharmacologic therapy is used in the treatment of acute asthma?

Answer 34

Beta-2 adrenergic agonists

Question 35

Inhaled corticosteroids require how long to work?

Answer 35

3-4 weeks

Question 36

What are the onset and peak times in minutes for beta-2 adrenergic agonists?

Answer 36

Onset: 1-5 mins Peak: 30-60 mins

Question 37

What are some possible side effects of beta-2 adrenergic agonists?

Answer 37

``` "The asthma paradox" Tolerance and tachyphylaxis Cardiovascular effects (hyper) Metabolic effects (hypo) ```

Question 38

How do muscarinic antagonists work?

Answer 38

Block muscarinic receptors in smooth muscle - Decrease vagal tone - Direct bronchodilating effects

Question 39

Which drug was formulated for asthma in 1922 and has since been replaced by beta agonist and glucocorticoids?

Answer 39

Theophylline

Question 40

What is the link between asthma and magnesium?

Answer 40

Severe magnesium deficiency can cause bronchospasm Magnesium is a proven bronchodilator