Asthma highlights Flashcards
1) List 4 common causes of chronic cough in adults
2) Name 1 less common cause of chronic cough
3) Name the 4 least common causes
1) Asthma, COPD, Smoking, Post infectious (CAP, bronchitis, etc)
2) OSA
3) Cancer
IPF, sarcoidosis
Lung abscess
PTX
What is the triad of asthma risk factors?
1) Infant atopic dermatitis,
2) Childhood AR
3) Asthma
1) Are asthma Sx episodic or chronic? Explain
2) Is the airway obstruction reversible?
1) Episodic Sx, but chronic airway inflammation
2) Yes; Reversible Airflow obstruction
For asthma:
1) Onset
2) Duration
3) Characterization
1) Typically during childhood (male), adult onset less common (female)
2) Chronic with episodic flare ups
3) Reversible airway obstruction
Asthma is heterogenous; what is the most common phenotype?
Allergic asthma
Breast feeding is associated with ___________ risk of asthma
reduced
What is the Samter Triad?
1) ASA/NSAID sensitivity
2) Nasal polyp
3) Asthma
List the onset, duration & timing, and character of asthma presentation (OLDCARTS pt 1)
1) Onset: typically as child/teen but manifest in adults
2) Duration, Timing: chronic but episodic, variable severity (mild intermittent to persistent symptoms), daytime and or nighttime symptoms
Location: respiratory
3) Character: reversible episodic symptoms - tightness in chest, wheezing, dyspnea, coughing (usually dry cough)
List the aggravating factors, alleviating factors, radiation and assoc. Sx of asthma presentation (OLDCARTS pt 2)
1) Triggers (smoke, smells, allergens, stress, aspirin, exercise), to include RTI
2) Relaxation, avoidance of triggers
3) Typically isolated to respiratory system
4) Atopic dermatitis/eczema, allergic rhinitis, nasal polyps, snoring
True or false: Asthma VS & Chest exam may be normal between episodes
True
Severe asthma exacerbation
1) What is a concerning finding for impending respiratory failure?
2) What are other signs of severe asthma exacerbations? What may cause these signs?
1) Globally reduced breath sounds and prolonged expiration
2) Patient in acute distress, cyanotic, hypoxic, and mental status changes (confusion)
-Pulse oximetry indicating hypoxia < 90%
1) What should be performed in all pts at time of Dx?
2) What is this key for?
3) What should you do if pt is <5 y/o and can’t do this test?
1) Should be performed in all patients at time of diagnosis
2) To confirm diagnosis
3) A therapeutic trial of Rx is recommended as they can not perform spirometry
1) Define FEV1% predicted
2) Define FEV1/FVC
1) FEV1 as % of predicted FEV1 using demographic data (age, Ht., gender, & race)
2) Measure of obstruction as a %
What is the spirometry diagnostic criteria for asthma in adults?
1) Reversibility indicated by FEV1 % predicted increased >/= 12% post SABA
AND
2) FEV1 Increase of 200 mL
What is the spirometry diagnostic criteria for asthma in kids <12 y/o?
FEV1 % predicted increased >/= 12% post SABA (Reversibility)
Spirometry reports:
1) What are used for predicted values?
2) Differentiate between base and base +
3) Differentiate between post and post +
1) Demographics used for predicted values
2) Base = pre-SABA
Base + = best values from 3 trials
3) Post = post SABA
Post + = best values from 3 trials
National asthma education & prevention program (NAEPP) recommends classifying asthma ___________ based on reported asthma symptoms at diagnosis to determine ___________ __________.
severity; initial therapy
NAEPP recommends recommends assessing degree of asthma __________ using validated clinical tools
control
Based on severity and control of asthma symptoms, use a _____________ approach for therapy
step wise
For NAEPP step 2 (mild persistent asthma), what should you Rx?
PRN ICS + SABA
For NAEPP step 3+ in pts >4 y/o, what should be considered as a daily and rescue Rx?
SMART therapy
SABA increases FEV1 in _________ minutes
3-5
Short acting antimuscarinic antagonist(SAMA):
Slower onset of action than SABA when used as monotherapy , ~ 15 minutes,
The most effective maintenance Rx is what? Why?
ICS (inhaled corticosteroids); addresses inflammatory component of asthma
What are the 2 ways to use ICSs?
PRN or scheduled use + SABA OR part of SMART Rx
1) When can you use oral corticosteroids?
2) Give examples of oral corticosteroids
3) How long should you use these?
1) Typically reserved for acute exacerbations that do not respond to increase in step therapy
2) Prednisolone, Dexamethasone, Methylprednisolone
3) Limited to 3-7 days
______________ is not typically recommended as monotherapy for asthma (has FDA warning of increased hospitalization, Intubation, & death)
LABA
What is not typically recommended as monotherapy or 1st line add on to ICS for asthma?
Long-acting muscarinic antagonist(LAMA)
1) Name a Leukotriene receptor antagonist (LTRA)
2) Do they work as monotherapy?
1) Singular (montelukast)
2) Yes, but ~half as effective as ICS
How is formoterol classified?
LABA; has duration of LABA, but the onset of action of a SABA
Montelukast has FDA warning regarding what?
Behavior, mood, & suicide
What does SMART stand for?
Single medication for Maintenance And Rescue Therapy
True or false: at follow-up asthma visits you should asses with both the ACT (asthma control test) and GINA
True
Singular (montelukast) MOA?
Block action of leukotriene at receptor (LTRA)
What is the best option when ICS monotherapy isn’t enough?
Add LABA (formoterol) to ICS (via SMART therapy >4 y/o)
For allergic asthma, _________________ immunotherapy may be considered for adjunct therapy in patients 5 + y/o with mild to moderate persistent asthma with proven allergies
subcutaneous
What type of immunotherapy is not recommended or FDA approved for asthma?
Sublingual immunotherapy
What should you check in severe asthma? Why?
1) Serum eosinophiles & IgE levels
2) IgE mediated allergic asthma responsible for ~ 50% of difficult to control asthma
What do all monoclonal antibodies have in common as far as naming conventions go?
all end in -mab
List the 4 types of pneumococcal vaccine and what type each is
Pnemococcal conjugate vaccines:
1) PCV-15 = Vaxneuvance
2) PCV-20 = Prevnar-20
3) CV-21 = Capvaxive
Pneumococcal polysaccharide vaccine:
4) PPSV-23 (Pneumovax 23)
What vaccines should asthma patients get? (4)
What else should they do?
not highlighted, just emphasized in class
1) Influenza: annual
2) COVID-19: annual?
3) RSV for 60+: q 2 years?
4) Pneumococcal: early in high risk
-Quit smoking
1) For adults 50+, the new recommendation includes the option of a PCV 15 followed in _________ by PPSV 23.
2) For high risk patients after childhood vaccination, when can they
1) 1 year
2) PCV 15 followed in 8 weeks by PPSV 23
Differentiate b/t Tdap and DTaP:
1) What is Tdap? How is it different from DTaP?
2) What is the purpose of DTaP?
3) What is the purpose of Td?
1) Tdap is a booster for already vaccinated with DTaP
Has lower dose.
2) DTaP is to provide primary vaccination/immunity against diphtheria, tetanus, and pertussis
3) Td is a booster just for tetanus and diphtheria
What are the 5 As of smoking cessation?
“need to know”
Ask: every patient every visit if they smoke
Advise: every smoker to quit
Assess: willingness to cut back or quit
Assist: with FDA approved Rx
-Nicotine replacement: gum, lozenges, patches
-Wellbutrin SR (Zyban)
-Varenicline (Chantix)
Arrange follow up: in person, tele-med, phone, text, email, etc.
True or false: Inadequate control of asthma poses a greater risk to the fetus than asthma medications
True
Asthma in pregnancy:
1) Preferred rescue?
2) Preferred controller?
1) Albuterol is the preferred rescue
2) ICS are preferred controller (budesonide preferred)
True or false: There are different severities of asthma exacerbations
True
What two things must a pt have regarding asthma exacerbation plans?
1) Patient should have and follow written asthma action plan
AND
2) Must have the medication on hand
Home based asthma management is based on what?
Written asthma action plan
