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Pulmonology - OMS 2 > Asthma Clinical Approach > Flashcards

Asthma Clinical Approach Flashcards

1
Q

3 populations most commonly affected by asthma

A
  1. adult
  2. female
  3. hispanic or white
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2
Q

Asthma is caused by a release of inflammatory mediators that lead to which 4 physiologic responses?

A
  1. increased airway secretion
  2. mucous plugging
  3. bronchospasm
  4. bronchoconstriction
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3
Q

What is the main differences between aeroallergens and animal allergens?

A
  • aero: mites, pollen, grass, etch
  • animal: dog, cat, zoonotic animals

(other category is non-allergic)

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4
Q

non-allergic asthma triggers (5)

A
  1. viral/bacterial infection
  2. tobacco
  3. strong odors (perfume)
  4. cold air
  5. medicine
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5
Q

6 Risk factors for asthma

A
  1. fam hx
  2. presence of IgE
  3. lower socioeconomic status
  4. infantile obesity
  5. low exposure to microbes
  6. vit D defiiency in utero
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6
Q

asthma sx (4)

other than wheezing

A
  1. non-productive cough
  2. SOB
  3. Cp
  4. fatigue
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7
Q

List the corticosteroids used to tx asthma (5)

A
  1. fluticasone
  2. baclomethasone
  3. mometasone
  4. budesonide
  5. ciclesonide

“-asone” or “-esonide”

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8
Q

List the 4 LABA - ICS combos that are used for moderate to severe asthma

this improves compliance = better asthma control

A
  1. advair
  2. breo
  3. dulera
  4. symbacort
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9
Q

List the 2 LABA-ICS combo meds that contain fluticasone. What are they paired with?

A
  1. advair: salmeterol
  2. breo: vilanterol
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10
Q

List the 2 LABA - ICS combos that contain fomoterol. What is it paired with?

tx moderate - severe asthma

A
  1. symbacort: budesonide
  2. dulera: mometasone
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11
Q

list the 2 rescue inhalers for asthma

A
  1. symbacort (fomoterol + budesonide)
  2. albuterol
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12
Q

SLIT

A

sublingual immunotherapy

used for allergic rhinitis

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13
Q

Which immuno therapy is recommended for allergic asthma? Which for allergic rhinitis?

aeroallergen or allergen

A
  • immunotherapy shots
  • SLIT
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14
Q

How can patients avoid asthma triggers (2)?

A
  1. allergy testing
  2. checklist at home

60% have allergic asthma

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15
Q

How does ashma lead to airway obstruction (decreased lumen diameter) (3)?

A
  1. adaptive immune response
  2. smooth msk contraction –> bronchospasm & constriction
  3. viscous mucus secretions
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16
Q

non-allergic asthma inflammatory response is aka

A

neutrophilic

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17
Q

Describe the early and late allergic asthma response.

A
  • 30 min: immediate IgE-induced mast cell degranulation
  • 12 hours: immune cell infiltration
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18
Q

In the “doorway view” of an asthma c/c, what should you notice first (4)?

A
  1. can they speak in full sentences
  2. what position are they in (tripod?)
  3. retractions (substernal)
  4. nasal flaring
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19
Q

DDx for asthma (10)

A
  1. vocal cord dysfxn
  2. pneumonia
  3. bronchitis
  4. URI
  5. FB obstructino
  6. CHF
  7. PE
  8. COPD
  9. anxiety
  10. GERD
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20
Q

C/C asthma: pert +/-

A
  1. dyspnea at rest? w/exertion?
  2. cough (non-productive)?
  3. exposure (new house, pet)
  4. chest pain

(must distinguish from MI)

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21
Q

C/C asthma: fam hx questions (3)

A
  1. asthma
  2. atopy
  3. seasonal allergies
22
Q

How can asthma become fatal?

A

prolonged expirations overtime = acidosis

23
Q

4 s/sx severe asthma attack

A
  1. retractions
  2. difficulty speaking full sentences
  3. altered mentation
  4. prolonged expiratory phase

note in Objective findings under lungs, not MSK (retractions)

24
Q

3 findings on physical exam: asthma

A
  1. hyper-resonance (increase vocal fremitus)
  2. diminished breath sounds
  3. wheezing
25
Q

What does expiratory wheezing indicate?

A

obstruction

26
Q

what does monophasic wheezing indicate?

A

obstruction

27
Q

describe monophasic wheeze

A

high-pitched squeak

best heard over lower neck

28
Q

what does polyphonic wheezing indicate?

multiple airways obstructed

A

asthma

29
Q

polyphonic wheeze is only heard on exhalation/inhalation. monophonic wheeze is only heard on exhalation/inhalation.

A

polyphonic = exhalation
monophonic = both

30
Q

polyphonic wheezing is also heard in bronchitis, CHF and ______.

A

PE

31
Q

What does asymmetric wheezing suggest (3)?

A
  1. pneumothorax
  2. pneumonia
  3. foreign body
32
Q

management of acute dyspnea following asthma trigger for mild or moderate exacerbation?

(O2>94%, tachycardia, tachypnea)

A
  1. prednisone
  2. O2
  3. SABA
33
Q

management of acute dyspnea following asthma trigger for severe exacerbation (8)

A
  1. ABC
  2. O2 (>92%)
  3. high dose SABA
  4. muscarinic antagonist (ipratropium)
  5. duo-neb (atrovent)
  6. IV corticosteroid (oral just as good)
  7. magnesium sulfate (relax sm. msk)
  8. intubate (if impending failure)
34
Q

Define Duo-neb (atrovent)

A

albuterol + ipratropium

SABA + Antimuscarinic

35
Q

If the patient is hyperventilating, how do they become acidodic?

A
  • ABG low CO2 at first
  • then they fatigue & retain CO2

this leads to altered mentation & death

36
Q

Which dx testing for asthma can be done in the office

primary care

A
  1. peak flow
  2. spirometry
37
Q

normal FEV1/FVC ratio

A

70%

38
Q

Why are PFTs normal in asthma patients at times?

A

asthma is episodic/reversible

39
Q

Lab findings for asthma (2)

A
  1. charcot-leyden crystals
  2. curshmann spirals
40
Q

what are curshmann’s spirals?

A

spiral-shaped mucus plugs

41
Q

what are charcot-leyden crystals?

A

indicative of eosiniphilic infiltration

42
Q

co-morbidities of asthma (5)

A
  1. GERD
  2. OSA
  3. allergic rhinitis
  4. sinusitis
  5. nasal polyps
43
Q

poor prognosis factors of asthma

A
  1. fatigue
  2. pulsus paradoxus
  3. diaphoresis
  4. decreased breath sounds
  5. cyanosis
  6. bradicardia
  7. acidosis
44
Q

aspirin nasal-polyposis syndrome

(samter’s triad)

A
  1. bronchial asthma
  2. nasal polyps
  3. intolerance to COX-1 inhibitors

non-allergic hypersensitivity rxn (non-IgE mediated)

45
Q

Eosinophilia and cross-reactivity between ASA (and other NSAIDs) is seen in which condition?

A

Aspirin sensitiviy-nasal polyposis syndrome

46
Q

What is the correlation between asthma and GERD?

A

stomach acid aspiration irriates airways –> bronchospasm

47
Q

When might you suspect GERD in an asthma patient?

A

not responding to steroids

put them on PPI

48
Q

What is included in astham action plan (3)?

A
  1. increrase controller & reliever meds if worsening
  2. take short-course oral steroids for severe exacerbation
  3. when to seek medical help
49
Q

Why are nebulizers not recommended? What is the alternative?

A
  • dissemination of virusespressurized metered dose
  • inhaler via spacer (mouth piece or tightly fitting mask
50
Q

define fractional exhaled nitric oxide test. when is it used?

A
  • measures NO2 (increased w/airway inflammation
  • confirms asthma
51
Q

What is bronchial thermoplasty (BT)

A

heat application to relax msk around airways

used for persistant asthma in adults

Pulmonology - OMS 2 (28 decks)

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