Asthma - Exam 1 Flashcards
Define asthma. What are some common triggers?
Defined as a REVERSIBLE obstructive lung disease caused by increased reaction of the airways to various stimuli or triggers
infections, viruses such as colds, cigarette smoke, allergens, pollutants, cold air/changes in temperature, excitement/stress and exercise.
Asthma has ______ contributing factors. Name them
multiple
Inflammatory cell infiltration with eosinophils, neutrophils and lymphocytes (specifically T-lymphocytes)
Goblet cell hyperplasia
Plugging of small airways with thick mucus
Hypertrophy of smooth muscle
Airway edema
Mast cell activation
When mast cells release histamines, leukotrienes and other inflammatory mediators what effect does it have on the airway?
leads to vasodilation -> edema
goblet cell hyperplasia leads to increased mucous secretion
bronchial smooth muscle contraction
which ALL lead to airway obstruction
What is THE STRONGEST IDENTIFIABLE PREDISPOSING FACTOR FOR DEVELOPMENT OF ASTHMA?
atopy
What is atopy?
the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma and atopic dermatitis (eczema).
What are risk factors for asthma?
obesity
ASA/NSAIDS
family hx
exercise
URIs
BB
environment
stress
GERD
weather
pollutants
respiratory irritants
viruses
When does asthma begin? What is the common scenario that makes you think asthma in a child? What are the different types of asthma?
77% of asthma begins in children <5 years old
3rd episode of wheezing in a kid under 2 years old
extrinsic
intrinsic
mixed
occupational
drug induced
exercise induced
cough variant
How do you confirm the dx of asthma? What are some common PE findings?
spirometry!!
bad skin
watery eyes
shiners
allergic salute
cough
chest tightness
SOB (not speaking in full sentences in kids)
What does auscultation sound like in a patient with asthma? What does it indicate if you do not hear anything when you auscultate?
Rhonchi to wheeze (usually expiratory but may be inspiratory as well)
Prolonged expiratory phase
severe asthma!! crisis!! do not hear anything because no air is being exchanged
What is the diagnostic criteria specific markers on spirometry that indicate asthma? What makes it different than COPD?
Asthma responds well to bronchodilators so spirometry markers should improve
_______ is indicated next for adults with FEV1 that is above 65% whose spirometry is nondiagnostic. What is the medication?
Bronchoprovocation Testing
Use of inhaled histamine, methacholine, or mannitol
Other than spirometry and bronchoprovocation testing, name some additional tests for asthma
Exercise Challenge
Peak Flow Meters
Chest X ray
Skin Testing
Measurement of sputum for eosinophils
What does a chest xray of a pt with asthma usually show?
Can be normal or show hyperinflation, bronchial wall thickening, and diminished peripheral lung vascular shadows
What can a CXR show you if you suspect your pt has asthma?
excludes other diagnoses and complications
Name some diagnostic labs that may be helpful in dx asthma. Give what each lab test might tell you.
ABGs: hypoxemia or hypercarbia
CBC: eosinophilia, increased levels of IgE
Sputum sample:
-may show casts of small airways
- thick, mucoid sputum
-Curschmann’s spirals
-Charcot-Leyden crystals
T/F: Curschmann’s spirals and Charcot-Leyden crystals are specific to asthma.
FALSE!! NOT diagnostic for asthma, they may be seen in other diseases processes
What is happening during the methacholine challenge? What pt population?
Patients breathe in increasing amounts of methacholine and perform spirometry after each dose
Increased airway hyperresponsiveness with a ≥ 20% decrease in FEV1 up to 16 mg/mL max dose
_____ is the most common bronchoprovocation test in the US
Methacholine Challenge
What time of the day are asthma s/s usually the worst?
Symptoms at night / early morning
What is laryngotracheomalacia?
weak, floppy vocal cords that a kid outgrows around 12 months of age. Can present like a large airway obstruction
**What are the classifications of asthma?
mild intermittent
mild persistent
moderate persistent
severe persistent
**What defines mild intermittent asthma?
**What defines mild persistent asthma?
**What defines moderate persistent asthma?
**What defines severe persistent asthma?
What is the job of inhaled steriods? Bronchodilators?
to protect and prevent asthma
relievers of asthma
What class of medication is referred to as the “rescue inhalers?”
Short Acting Inhaled Beta-2 Agonist (SABA)
albuterol and levalbuterol
T/F: SABAs be given to ANYONE diagnosed or experiencing asthma symptoms
TRUE!, don’t leave home without it
Which SABA does NOT increase HR? What are the SEs?
levalbuterol
Tachycardia
Nervousness
Shakiness
Pulmicort (budesonide)
Qvar (beclometasone)
Asmanex (mometasone furoate)
Flovent (fluticasone propionate)
What drug class?
MOA?
How are they dosed? How long does it take to see the intended effect?
inhaled corticosteroids
Works to reduce airway inflammation and reduces the airway’s exaggerated sensitivity to any and all triggers of asthma
BID
takes 1 weeks for steroids to get into pt’s system and before they start to see improvement in s/s
Thrush
Hoarseness (dysphonia)
Localized contact hypersensitivity
Cough and throat irritation
These are common SEs of ______
inhaled corticosteroids
What are the pt education points for inhaled corticosteroids?
Rinse mouth
Regular eye exams with h/o or family h/o glaucoma
Monitor growth in children on ICS (BMI <15%); cortisol levels
Watch calcium and Vit D intake in women and children on ICS
Which inhaled corticosteroid is preferred in pregnancy?
Budesonide
or Proventil
Which systemic corticosteroids are used in asthma? Give form of each
Prednisone - multiple pill forms (10mg, 20mg, etc.)
Prednisolone (Prelone, Orapred) - liquid form (15mg/5ml)
Solu Medrol (Methylprednisolone) - 20/40/80 mg IM or IV injection
______ affects smooth muscle not limited to the airways and therefore can affect smooth muscle in the heart causing tachycardia and palpitations
LABAs
salmeterol
formoterol
arformoterol
What is the benefit of using a ICS and LABA?
Beneficial because you have the bronchodilator working to widen the airway + inhaled corticosteroid that reduces and prevents inflammation of the airway
What is the MOA for SAMA/LAMA? Are they first line in asthma?
Relax the airways and prevent them from getting narrower
Also reduce the amount of mucus in the airway
NOT first line in asthma but can be used if unresponsive to therapy in combination with SABA
_____ is a nonselective phosphodiesterase enzyme inhibitor. What is the MOA? Is it used in exacerbations? What is the monitoring?
Theophylline
Mild bronchodilation, anti inflammatory, enhances mucociliary clearance, and strengthens diaphragmatic contractility
NOT used in acute exacerbation only as an add on for severe asthma
have to check blood levels
______ Blocks the actions of cysteinyl _____ at the CysLT1 receptor on target cells such as bronchial smooth muscle via receptor antagonism. What is the BBW?
leukotrienes
leukotrienes
neurologic behavior, aggression
______ Improves asthma symptoms and reduces exacerbations and limit markers of inflammations such as eosinophil counts in the peripheral blood and bronchoalveolar lavage fluid proving they have antiinflammatory properties. What are the 2 drugs in this class?
Leukotrienes
montelukast
zafirlukast
______ is NOT used first line. may be an option if someone fails or can’t tolerate ICS. Only available as a nebulizer. What is the MOA?
cromolyn
mast cell stablizer
_______ used in patients with severe asthma attacks and results in rapid improvement of upper airway obstruction. SE include restlessness, anxiety, tachycardia.
Nebulized Epinephrine - Racemic
______ is a monoclonal antibody that is DNA-derived, IgG antibody which binds to IgE mast cells and reduces the mediator release that produces the allergic response. Injection only. How old? What is the BBW?
Omalizumab (Xolair)
6 years of age and older
BBW: anaphylaxis
_____ is indicated for doderate-severe uncontrolled asthma in person w/ positive skin prick testing to ______ allergies who is inadequately controlled on max dose of other meds
Omalizumab (Xolair);
perennial
What are the 6 steps of asthma tx according to GINA?
What vaccinations are recommended for pts with asthma?
Influenza
Pneumococcal
COVID
What is the routine f/u for pts with asthma? What if you start a new medication?
every 1-6 months
2-6 week follow up after any new med is administered to reassess function
peak flow meters the predicted values are _____ in black and hispanic patients
10% lower
How do you determine if asthma is well controlled?
What are the goals of asthma treatment?
When should you refer a pt to a pulmonologist?
_____ A condition in which the airways narrow significantly during vigorous exercise. What is the tx? What is the pt education?
exercise induced asthma
SABA
Take 15 - 30 min. before exercise
chronic cought for > 3 weeks
Non-productive
Usually nocturnal, but can occur anytime
PFT/spirometry is normal
What am I?
What is the tx?
cough variant asthma
tx: similar to other forms of asthma
T/F: all asthma attacks give a warning
TRUE!!
Increased SOB or wheezing
Disturbed sleep caused by SOB, coughing or wheezing
Chest tightness or pain
Increased need to use bronchodilators (SABAs)
A fall in peak flow rates as measured by a peak flow meter
What am I?
When should the pt be sent to the ER?
acute asthma attack
Oxygen falls below 90% or pt is drowsy/confused
_____ is the most severe form of asthma. What is going on?
Status asthmaticus
The lungs are no longer able to provide the body with adequate oxygen or remove carbon dioxide, organs begin to malfunction, build up of CO2 leads to acidosis, BP falls
What is the tx for status asthmaticus?
Require intubation and ventilator support as well as maximum doses of several medications
support to correct the acidosis
