Asthma Comorbidities (Mod 10) Flashcards
What is the Asthma Paradox?
Over reliance on SABA; rather than ICS/LABA use (preferred controller method)
- asthmatics typically treated the symptoms (bronchoconstriction) but not the underlying causes of inflammation
What is the preferred method to prevent asthma exacerbations?
ICS/LABA (initial starting settings)
Insert GINA 2023 (slide 5) and know the step ups…and drugs associated with each step
What is Severe asthma on the GINA guidelines?
Steps 4-5 w/key being high dose ICS therapy for a year or OCS to maintain control for at least half of the year
When assessing asthma severity, what should be taken into consideration before stepping up on the GINA guidelines?
Checking patient education, compliance, technique, , , incorrect diagnoses,and triggers.
- sometimes the asthma is not controlled as well, so it may not truly be within a step category within GINA
- Asthma severity is not static***
add slide 7
What is asthma often mistaken with?
VCD
What do comorbities and complicating conditions have to do with asthma?
May incorrectly associate symptoms witho other conditions with asthma
Add slide 8 later
Slide 9
How of ten is asthma response assessed in controlled asthma
every 3-6 months
What are the 2 phenotypes of airway inflammation
Type 2 inflammation and non type 2 inflammation
What is Type 2 Inflammation charactized by?
Cytokines (IL-4, IL-5, and IL-3) aka immune response to allergens. The following values would be expected:
- Sputum eosinophils > 2%
- blood eosinophils > 150/ul
- FeNO (fraction of examples nitric oxide) > 20 ppe
What is Type 2 Inflammation accompied by?
Autopsy, often refractory to high dose ICS
How is Type 2 Inflammation treated?
Treat type 2 comorbidites (nasal polyps, atopic dermatitis) etc. etc.
Why are oral corticosteroids (OCS) the end game treatment for asthma?
OCS has quite a bit of side effects
What is non type 2 inflammation characterized by?
Neutrophils
What are non type 2 inflammation treatments?
Add on treatments (LAMA, LTRA, Low dose macro life, low dose OCS as last resort)
- Biologics are not a first line treatment option, but particular biological may be trialed
What is Bronchial thermoplasty?
Thermal heat applied to selective ablate airway smooth muscles
What does Bronchial Thermoplasty have to do with non type 2 inflammation?
Bronchial thermoplasty is a procedure used to treat severe asthma by delivering controlled thermal energy to the airy walls, reducing the amount of smooth muscle in the airways.
- only effective for type 2 airway inflammation, not non
What is Biological Therapy?
An expensive IV/SC route to manage severe asthma (anti-i’ve for example)
What are side effects of Biological therapies for asthma?
INjection site reactions, anaphylaxis, immunosuppressive
What is the step wise approach?
A asthma treatment guideline for paediatrics
Assuming no side effects, how long do Biological Trials run for?
Trial for at least 4 months, don’t d/c for 1 year.
- shots are done weekly
How do Biological therapies work?
- need to confirm****this slide doesn’t make sense
Uses thermal energy to reduce muscle associated with airway constriction in asthma patients
- via Bronchial thermoplasty
Common side affects of bronchodilators?
Increased HR
Understand the asthma severity assessment card (slide 21)
Super similar to pram score stuff
Goals of management for acute asthma exacerbations?
Early treatment with special attention to patient who are at high risk of asthma related events (aka visit the hospital early if relievers dont’ work)
- Ventilatory support (NIPPV/Invasive)
- Correctino of severe hypoxemia
- Rapid reversal of air flow obstruction and inflammation via early treatment w/bronchodilators, corticosteroids, and adjunctive therapies
- appropriate disposition decision making
when should Bronchodilators be given via nebulizers vs mdi?
If sats drop below 85%
Make a card for each med type in slide 23
Add slide for other diagnotistic considerations (slide 24)
Risk factors for Fatal Exacerbations
- Previous ventilation/ICU admissions/Hypercapnea
- Previous asthma admission/ER visits
- Requiring multiple classes of medications
- Increased reliance on SABA
- Poor medication adherence (not using ICS)
- Older age
- Poor perception of breathlessness (delays treatment)
- Recent use of systemic corticosteroids
- No asthma action plan
- Psychosocial Factors
Indications for intubation?
Deteriorating LOC
- Exhaustion, fatigue, respiratory efforts, silent chest
- Onset/progression of hypercarbia (ABG/etCO2)
- Persistent hypoxemia despite oxygen therapy/NIV
- Persistent instability (consider intubation pharmacology)
What is dynamic hyperinflation?
- need to confirm
Air just can’t get out???? can lead to hemodynamics instability
Intubation is generally avoided for asthma, what strategies should you try first?
Maximize med therapies and NIV
- ideal niv candidates would demonstrate persistent airflow limitations/respiratory fatigue, but normal vital signs
What strategy can be used to help vent an asthmatic patient who is intubated?
Manually vent the patient by pushing their abdomen in
General Asthma ventilation strategies?
lung protective strategies (low Vts, permissive hypercapnia)
- High inspiratory flow rate
- Long Term
- Observe for dynamic hyperinflation
- Use PEEP w/caution (5 or lower!)
- may need to disconnect circuit to allow for exhalation if hemodynamics are suffering
- Anesthetic agents (bronchodilation effects)
Discharge planning for Severe Asthma?
Adequate oxygenation and responsive to treatment (significant improvement in PEF)
- Able to manage symptom burden as outpatient
- Medication; continue oral corticosteroids for 5-7 day, intimate ICS if not already taking.
- Outpatient follow up (consult) within 2 weeks
What is dynamic hyperinflation?
When there is insufficient time for exasbaration during breathing, leading to an increase in end expiratory lung volume during tidal breathing.
- Air gets trapped (causing auto peep as well)
- reducing subsequent breaths
- COPDers usually expierence this, but asthmatics can do, the difference is asthmatics have trouble getting air in as well
