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Patho 3 (Path 312) > Asthma Comorbidities (Mod 10) > Flashcards

Asthma Comorbidities (Mod 10) Flashcards

1
Q

What is the Asthma Paradox?

A

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
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2
Q

What is the preferred method to prevent asthma exacerbations?

A

ICS/LABA (initial starting settings)

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3
Q

Insert GINA 2023 (slide 5) and know the step ups…and drugs associated with each step

A
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4
Q

What is Severe asthma on the GINA guidelines?

A

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

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5
Q

When assessing asthma severity, what should be taken into consideration before stepping up on the GINA guidelines?

A

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***
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6
Q

add slide 7

A
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7
Q

What is asthma often mistaken with?

A

VCD

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8
Q

What do comorbities and complicating conditions have to do with asthma?

A

May incorrectly associate symptoms witho other conditions with asthma

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9
Q

Add slide 8 later

A
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10
Q

Slide 9

A
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11
Q

How of ten is asthma response assessed in controlled asthma

A

every 3-6 months

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12
Q

What are the 2 phenotypes of airway inflammation

A

Type 2 inflammation and non type 2 inflammation

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13
Q

What is Type 2 Inflammation charactized by?

A

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
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14
Q

What is Type 2 Inflammation accompied by?

A

Autopsy, often refractory to high dose ICS

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15
Q

How is Type 2 Inflammation treated?

A

Treat type 2 comorbidites (nasal polyps, atopic dermatitis) etc. etc.

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16
Q

Why are oral corticosteroids (OCS) the end game treatment for asthma?

A

OCS has quite a bit of side effects

17
Q

What is non type 2 inflammation characterized by?

A

Neutrophils

18
Q

What are non type 2 inflammation treatments?

A

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
19
Q

What is Bronchial thermoplasty?

A

Thermal heat applied to selective ablate airway smooth muscles

20
Q

What does Bronchial Thermoplasty have to do with non type 2 inflammation?

A

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
21
Q

What is Biological Therapy?

A

An expensive IV/SC route to manage severe asthma (anti-i’ve for example)

22
Q

What are side effects of Biological therapies for asthma?

A

INjection site reactions, anaphylaxis, immunosuppressive

23
Q

What is the step wise approach?

A

A asthma treatment guideline for paediatrics

24
Q

Assuming no side effects, how long do Biological Trials run for?

A

Trial for at least 4 months, don’t d/c for 1 year.

  • shots are done weekly
25
Q

How do Biological therapies work?

  • need to confirm****this slide doesn’t make sense
A

Uses thermal energy to reduce muscle associated with airway constriction in asthma patients

  • via Bronchial thermoplasty
26
Q

Common side affects of bronchodilators?

A

Increased HR

27
Q

Understand the asthma severity assessment card (slide 21)

A

Super similar to pram score stuff

28
Q

Goals of management for acute asthma exacerbations?

A

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
29
Q

when should Bronchodilators be given via nebulizers vs mdi?

A

If sats drop below 85%

30
Q

Make a card for each med type in slide 23

A
31
Q

Add slide for other diagnotistic considerations (slide 24)

A
32
Q

Risk factors for Fatal Exacerbations

A
  • 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
33
Q

Indications for intubation?

A

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)
34
Q

What is dynamic hyperinflation?

  • need to confirm
A

Air just can’t get out???? can lead to hemodynamics instability

35
Q

Intubation is generally avoided for asthma, what strategies should you try first?

A

Maximize med therapies and NIV

  • ideal niv candidates would demonstrate persistent airflow limitations/respiratory fatigue, but normal vital signs
36
Q

What strategy can be used to help vent an asthmatic patient who is intubated?

A

Manually vent the patient by pushing their abdomen in

37
Q

General Asthma ventilation strategies?

A

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)
38
Q

Discharge planning for Severe Asthma?

A

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
39
Q

What is dynamic hyperinflation?

A

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

Patho 3 (Path 312) (10 decks)

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