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?