Asthma Exacerbation Flashcards
What are the two types of asthmatic response?
Early asthmatic response
- triggered by allergens
- peak bronchoconstriction within 15-20minutes, lasts 1-2 hrs
Late asthmatic response
- due to activation of inflammatory pathways
- seen 4-12 hrs after initial challenge
Which class of medication does not inhibit or attentuate EAR?
Steroids
Which two drugs are able to decrease hyperresponsiveness?
Steroids
Cromolyn
Which drugs are good for EAR control?
SA, LA, Cromolyn, Theophylline, Ipratropium, Omalizumab, LKA
Which drugs are good for LAR control?
LA, Steroids, Cromolyn, Theophylline, Omalizumab, LKA
Which demographic and sex are a risk factor for asthma exacerbations?
Female, nonwhite
When measuring PEF at home, how do you assess the severity of asthma?
50-79% of best or predicted indicates need for quick relief med
<50% best or predicted indicates immediate medical care
Note for any SOB and speech in phrases
What is the treatment algorithm at home?
Initial treatment: inhaled SABA up to two doses every 20 minutes of 2-6 puffs via MDI or nebulizer treatments
If good response (>80% PEF) –> continue SABA and maybe add steroid
If incomplete response (50-79%) –> continue SABA and add steroid –> contact MD
If poor response ( immediate SABA repeat and steroid –> call 911
What are some things that are not recommended for asthma management at home?
- Drinking large amounts of liquids
- Breathing warm, moist air
- OTC products like diphenhydramine
- Pursed lip breathing
Which methods of spirometry are used to diagnose patients with asthma and its severity?
Forced expiratory volume in one second (FEV1)
Peak expiratory flow (PEF)
FEV1 is recommended because it is less susceptible to cheating
What other ways other than spirometry are available to diagnose asthma? When would you use them?
Pulse oximetry
- PEF < 25% after initial treatment
When measuring PEF at the ED, how do you assess the severity of asthma?
70% PEF -> mild
40-69% -> moderate
severe
What is the treatment algorithm at the ED?
If mild to moderate (FEV1 or PEF > 40%)
- SABA MDI with VHC or neb up to 3 doses in 1 hr
- Give O2
- PO steroids
If severe (FEV1 or PEF < 40%)
- Hi dose SABA and anticholinergic by MDI with VHC or neb q20minutes in 1 hr
- Give O2
- PO steroids
In terms of ingredients, compare albuterol and Levalbuterol.
Albuterol is a racemic mixture while levalbuterol has only the active isomer (R-isomer)
What is the dosing of Albuterol? (ADULT)
NEBULIZER
2.5-5mg q20 minutes for 3 doses
THEN 2.5-10mg q1-4 hours PRN
MDI
4-8 puffs q20 minutes up to 4 hours
THEN q1-4 hours PRN