Asthma - Brown Flashcards
Asthma Symptoms
- Cough - with or without expectoration of excessive mucus
- Hemoptysis - part of Churg-Strauss vasculitis or allergic bronchopulmonary aspergillosis
- Shortness of breath
- Wheeze
- Chest tightness or pain
- Hyperventilation Syndrome
Asthma Control: Medications
follow-up every 1-6 months to make sure control is being maintained - use the lowest effective dose
Long-term control - medication taken daily to achieve and maintain control
- corticosteroids
- cromolyn sodium and nedocromil
- long acting beta-2-agonists
- leukotriene modulators
Quick-relief - medications taken to provide prompt relief
- short acting beta-2-agonists
- anticholinergics
- systemic corticosteroids
Complementary Alternative Medicine
- epinephrine
- ephedra
Asthma Exam Findings
- wheezing (cannot be used as a predictor of severity of airflow obstruction)
- use of accessory muscles of breathing - inspiration
- eczema, atopic dermatitis or other types of allergic skin disorders
Asthma History
- history of intermittent, seasonal waxing/waning of symptoms
- noctural episodes
- exacerbation of symptoms on exposure to:
- exercise
- excitement
- stress
- cold air
- aeroallergens (pollen, mold, animal dander)
- URI
- strong odors
Pathophysiology of Asthma
smooth muscle dysfunction
airway inflmmation
airway remodeling
Differential Diagnosis of Cough - Adults
- COPD
- Heart Failure
- PE
- Laryngeal dysfunction
- Tumor
- Pulmonary infiltration with eosinophilia
- Secondary to drugs
- Vocal cord dysfunction
- GERD
Differential Diagnosis of Cough - Children
- allergic, rhinitis and sinusitis
- foreign body in trachea or bronchus
- vocal cord dysfunction
- vascular rings or laryngeal webs
- enlarged lymph nodes or tumor
- cystic fibrosis
- heart disease
- GERD
Asthma Control Components (4)
- assessment and monitoring
- education for parternship in care
- control of environmental factors and comorbid conditions
- medications
Diagnosis of Asthma
Spirometry
FEV1 is the most important variable - declines in direct/linear proportion with obstruction; increases after successful treatment
FEV1/FVC ratio > 75 is normal
Histamine/methacholine challenge - increase dose until FEV drops 20%
Short acting bronchodilator - increase FEV >12% of 200 mL - significant reversibility
Definition of Asthma
chronic inflammation disorder
airflow obstruction
severe narrowing of the airways
wheezing, coughing, breathlessness, chest tightness
reversible
recurrent episodes
Risk Factors of Death from Asthma
- past hx of sudden severe exacerbations
- prior intubations for asthma
- admission to ICU for asthma
- 2+ hospitalizations for asthma
- 3+ ER visits for asthma
- low socioeconomic status
- >2 canisters/month of inhaled short acting beta-agonist
- current use of systemic corticosteroids
- difficulty perceiving airflow obstruction
- illicit drug use
Asthma Assessment Measures
Spirometry
- initially
- after treament and symptoms have stabilized
- every 1-2 years - assess maintenance of airway function
Peak-Flow Monitoring
- short-term monitoring management of exacerbations
- daily long-term monitoring
Asthma Pathophysiology - Smooth Muscle Dysfunction
exaggerated contraction
increased smooth muscle mass
increased release of inflammatory mediators
Asthma Control: Control Other Factors
- environmental factors allergens and irritants
- comorbid conditions - maximize treatment of other conditions
Asthma Control: Assessment & Monitoring
Severity - intrinsic intensity of the disease process; assessed in patient not receiving long-term control
Control - degree to which the manifestations of asthma are minimized by therapy
Responsiveness - ease with which asthma control is achieved by therapy
Impairment - symptoms, lung function by spirometry
**Risk of Adverse Events **
