Asthma Clinical, Management and Pharmacology Flashcards
is asthma restrictive or obstructive
obstructive.• Symptoms associated with variable airflow limitation. lung volume inhaled not reduced as if they had kyphosis or ALS, but trying to breathe in might be affected because something is obstructed.
how does ses influence asthma cases
Higher prevalence in children and those with lower socio-economic status
outline the pathogenesis of asthma
- allergen presentation
- mast cell recruitmen
- eosiniophil and neutrophil release cause epithelial shedding, sensory nerve activation, cholinergic reflex, bronchoconstriction/hypertrophy/hyperplasia
allergy causes a ____(low/normal/high) FEV1
low FEV1. due to mast cell release causing smooth muscle contraction, vascular permeability, eosinophil chemotaxis.
“big 3” atopic disease correlates
- asthma
- rhinitis
- eczema
- inflammatory A1 disease predisposition– genetic component
list some potential asthma triggers
asthma operational definition
- variable respiratory symptoms like wheezing, dyspnea, chest tightness, cough. May be triggered by various exposures.
spirometry findings of asthma
- reduced FEV1/FVC– restrictive disease
- INCREASE in FEV1 after a bronchodilator or after course of controller therapy.
- Peak expiratory flow has to increase by 20%.
if there as a methacholine challenge, check for a drop in FEV1.
if a person has a decreased FEV1 after a methylcholine challenge, it indicates ___ ___ ____
bronchial hyper repsonsiveness
what CBC findings might you see in asthma
- cbc: eosinophilia consistent with asthma.
differential diagnosis of adult wheezing/cough/dyspnea apart form Asthma
- COPD
- bronchiectasis ex/ cystic fibrosis
- chronic cough secondary to: post-infectious, upper airway cough syndrome, GERD
- upper airway obstruction
- foreign body aspiration
- Congestive heart failure
- hyperventilation syndrome
choosing wisely guidelines for giving people >6 years asthma medications
do not initiate medications in patients over 6 who have not had confirmation of reversible airflow limiation with spirometry, and in its absence, a positive methacholine or exercise challenge test, or sufficient peak expiratory flow variability.
outline which med class is: SABA
ICS
LABA
LAMA
LTRA
Antis
OCS
SABA: short acting beta adrenoceptor agonist First line
SAMA: short acting muscarinic antagonists AKA anticholinergics
ICS: inhaled corticosteroids
LABA: long acting beta adrenoceptor agonists- never use LABA alone– have to use ICS with it.
LAMA: long acting muscarinic antagonists (anticholinergics)
antibodies: monogloncal IGE, IL5 etc
OCS: Oral corticosteroids.
treatment classes that prevent bronchospasm/reduce inflammation/daily puffers
- ICS is the most important controler
- LTRA, ICS/LABA, LAMA as an addon, OCS, monoclonal antibody treatments.
When is an ICS controller indicated?
if there are any signs of poor control
- if well controled, can just used a SABA (beta agonist) puffer as needed during exacerbations.
- ICs’s have been shown to attenuate the late asthmatic leukotriene response as well as reduce exacerbation frequency.
why might someone develop hoarsness with ICS?
orophayngeal deposition.
How doo LABAs affect inflammation in the lungs long term?
LABAs are a muscarinic antagonist, but they also change gene expression to influence inflammation. Allows for greater control.
If asthma progresses to “severe,” and control inhalers as wel as acute bronchospasm inhalers no longer help, what control of medications should you consider?
- biologics
- Anti-igE therapy/omalizumab.
in the ED, what can you do to assess severity of asthma exacerbation?
- physical examination
- peak flow measurement
- blood gases.
• Careful monitoring for deterioration is essential
• Supplemental Oxygen for SpO 2> 92%
• SABA + SAMA q20min x 3
• Oral or IV • Magnesium Sulfate IV
• Continue SABA + SAMA q4h • SABA q1h PRN
• Systemic Corticosteroids
