Asthma DSA Flashcards
3 components
recurrent airway obstruction
airway hyper-responsiveness
airway inflammation
population affected
boys > girls
women > men
most cases onset is before 25
mild asthma
edema and hyperemia of mucosa plus mucosal infiltration w/mast cells, eos, and lymphocytes
moderate asthma
chemokines eotaxin RANTES macrophage inflammatory protein 1 alpha IL8 cause inflammation and smoothm constriction
severe asthma
hypertrophy and hyperplasia of airway glands and smooth m -> severe airway thickening
airway obstruction
constriction of smooth mm
thickening of airway epi
liquids in airway
Ach
released from intrapulmomary motor nn
stimulates M3Rs -> smooth m constriction
Histamine
released from mast cells
leukotrienes and lipoxins
derived by lipoxygeneration of AA released from target cell membrane phospholipids during cellular activation
NO
produced by airway epi and inflammatory cells
high levels during attack
mild intermittent asthma
symptoms present <=2nights/month
mild persistents
symptoms present >2days/wk, but 2nights/month
moderate persistent
symptoms present daily for >once/night
severe persistent
symptoms continual during day and frequent at night
PE
wheezing loudest on expiration
ABG
often mild hypocanpnea
if PaCo2 normalized during sever attack may indicate impending respiratory failure
PFT
obstruction
CBC
eos, IgE
CXR
often normal, maybe hyperinflation
severe asthma- pneumothorax or pneumomedstiunum
sputum
Eos
step 1 Tx
intermittent asthma
short acting beta agonist as needed
step 2 Tx
Mild persistent asthma
SABA as needed
inhaled corticosteroid
alternates: mast cell stabilizer, leukotriene R antagonist, theophylline
step 3 Tx
moderate persistent asthma SABA as needed low to med dose inhaled corticosteroid LABA alternates: increase in inhaled corticosteroids leukotriene R antagonist, theophylline
Step 4 Tx
severe persistent asthma SABA as needed high dose corticosteroid LABA prednisone
