Asthma -Goya Flashcards
What determines reversibility seen in asthma?
Reversibility is determined by an increase of FEV1 >200ml and >12% from baseline measured after inhalation of SABA
What is necessary to diagnose asthma?
Episodic symptoms of airflow obstruction or airway hyper-responsiveness
Airflow obstruction which is at least partially reversible
Alternative diagnoses have been excluded
How is asthma severity classified?
intermittent=80
mild=symptoms >2days/week (same amt of SABA use), nighttime awakenings 3-4 times /month. FEV1>80%
Moderate = daily symptoms, nighttime awakenings >1x/week, SABA use daily, FEV1 >60%, <60%
What is the preferred treatment for intermittent asthma?
SABA (short acting beta agonist) as needed
How should persistent asthma be treated?
start with a low-dose ICS
then can add a LABA OR do a medium dose ICS
then medium dose ICS + LABA
then high-dose ICS + LABA and consider amalizumab for pts with allergies
then high-dose ICS +LABA + oral corticosteroid and amalizumab
(step down if possible and if asthma is controlled for at least 3 months)
Can a LABA be given alone for the treatment of asthma?
NO!
LABA can be given in addition to ICS for the treatment of persistent asthma
LABA should not be used in pts whose asthma is well controled on low dose ICS
How is a mild asthma exacerbation treated?
short course of oral corticosteroids and removal of trigger (risk factors)
What are some signs of a severe asthma exacerbation?
- Dyspnea at rest
- Upright positioning
- Inability to speak in phrases or sentences
- Respiratory rate > 30 breaths/min
- Use of accessory muscles of respiration
- Pulse > 120 beats/min
- Peak expiratory flow rate (PEFR) < 50%predicted
- Hypoxemia ( PaO2 ??–> high)
- Can occur at any level of asthma severity
What are the possible PE findings in a severe asthma exacerbation?
Altered mental status
Paradoxical respiration
Bradycardia
Quiet Chest
Diaphoresis & accessory muscle use
cyanosis is a late finding
when should oxygen be given?
hypoxia (O2 sat <70mmHg in ABG)
Should a LABA be given in an acute asthma exacerbation?
NO!
SABA is the initial treatment of choice (albuterol is the most commonly used)
can also add ipratropium bromide for the initial SAE treatment
How should oral or IV corticosteroids be given in an SAE?
recommends 40-80 mg/day of either prednisone, methylprednisolone or prednisolone in 1 or 2 divided doses until PEF reaches 70% of personal best
Total course of corticosteriods for an asthma exacerbation may last from 3-10 days
When is an arterial blood gas recommended?
FEV1<200 L/min
early stages will show mild hypoxemia and reap alkalosis
severe disease =hypercapnia
