Asthma & Bronchospastic Diseases Flashcards
True or false: Asthma is a chronic inflammatory disorder
True
Asthma is underdiagnosed in what population?
Elderly
What is the primary contributor to fatal asthma?
Airway remodeling
What are some important preoperative considerations for the management of asthma patients?
Asthma related history: medicine**, triggers, hospitalizations
Other history: GERD, smoking, URIs etc
What type of test is used to assess occult bronchospasm and measure lung function?
Spirometry
Which lung volume Is the most reproducible PFT parameter?
FEV
What test is a better indicator of small airway involvement and is effort dependent?
FEF 25-75% spirometry
What will the arterial blood gas results look like in a patient with severe asthma?
Hypercarbia and hypoxia are indicative of severe disease
List a few of the precipitating causes of asthma
Allergens Pharmacologic agents Infections Exercise Emotional stress
30 to 80% of asthma patients also have what other exacerbating disease?
GERD
How does GERD Cause asthma or bronchospasms?
Aspiration of refluxed gastric contents
What are some common symptoms associated with aspirin induced asthma?
rhinitis and nasal polyps (70-80%)
The usage of what common drug during pregnancy is associated with childhood asthma?
Acetaminophen
25% of asthmatics smoke. why is this important?
They’re at increased risk of laryngeal and bronchial reactivity and they have a reduced response to corticosteroids
How long before surgery do you have to stop smoking before there will be decreased airway reactivity?
7 days
How long before surgery do you have to stop smoking before they will be reduced post-operative respiratory complications?
4 weeks
Chronic use of what illegal substance can cause hypersensitivity pneumonitis?
Crack
Isolated use of what illegal substance is a bronchodilator?
THC, marijuana, Mary Jane, weed, pot, reefer. Call it what you will. Shit stinks.
What additives in wine can trigger bronchospasm?
Sulfites
What is the most common cause of an upper respiratory infection?
Viral infection
What impact do URIs have on asthmatics?
Asthmatics suffer greater increase in airway reactivity
The risk of asthma increases by what percent per unit BMI?
7%
What are some important anesthetic considerations for patients with asthma?
Additional albuterol Anti-cholinergic Corticosteroids Benzodiazepines Avoid histamine releasing agents (morphine) Treat GERD Judicious use of NSAIDs
If feasible, what type of anesthesia is ideal for asthmatics?
Regional
Which induction agent depresses airway reflexes effectively?
Propofol
Which induction agent can depress neural airway reflexes but can also increase secretions?
Ketamine
True or false: There is no conclusive evidence that IV lidocaine alone protects against intubation induced bronchospasm
True
All volatile anesthetics have what effect on airways
Bronchodilators
Which volatile anesthetic elicits the least amount of airway reactivity at lower doses?
Sevoflurane
Why should you be judicious when using cholinesterase inhibitors?
They can increase secretions and promote bronchospasm
What is the most common cause of perioperative bronchospasm?
In adequate depth of anesthesia
How is a Perioperative bronchospasm treated?
Confirm diagnosis
Deepen anesthesia
Adjust ventilation
Pharmacologic therapy
What type of pharmacologic therapy is used in the treatment of chronic asthma?
Corticosteroids
What type of pharmacologic therapy is used in the treatment of acute asthma?
Beta-2 adrenergic agonists
Inhaled corticosteroids require how long to work?
3-4 weeks
What are the onset and peak times in minutes for beta-2 adrenergic agonists?
Onset: 1-5 mins
Peak: 30-60 mins
What are some possible side effects of beta-2 adrenergic agonists?
"The asthma paradox" Tolerance and tachyphylaxis Cardiovascular effects (hyper) Metabolic effects (hypo)
How do muscarinic antagonists work?
Block muscarinic receptors in smooth muscle
- Decrease vagal tone
- Direct bronchodilating effects
Which drug was formulated for asthma in 1922 and has since been replaced by beta agonist and glucocorticoids?
Theophylline
What is the link between asthma and magnesium?
Severe magnesium deficiency can cause bronchospasm
Magnesium is a proven bronchodilator
