Asthma Lecture Powerpoint

Question 1

____ is the most common chronic illness in children

Answer 1

Asthma

Question 2

____ is very important to proper management of asthma

Answer 2

Education

Question 3

Asthma is more common in ____ women than men, ____ than adults, and ____ race

How has the rate of asthma changed in the past 20 years?

Answer 3

• adult, children, african americans

- It has nearly doubled

Question 4

Obstructive asthma pathophysiology

Answer 4

A complex, often reversible disease derived from heredity and environment that due to many causes that see inflammation with recurring episodes of airflow obstruction (cannot get air out of small airways), bronchial hyperresponsiveness, and underlying inflammation triggered by some source

Question 5

Factors that play a role in causing of asthma (4)

Answer 5

• viral infection (RSV under age 1)
• genetics
• allergens
• poor air quality

Question 6

Hygiene hypothesis

Answer 6

Idea that early exposure to environments full of innocuous antigens (food, day care, farms, pets) provides protective effect against development of diseases such as asthma, atopic dermatitis, etc.

Question 7

Asthma is better treated if ____ can be identified and avoided

Answer 7

Triggers

Question 8

In uncontrolled chronic asthma, can see….

Answer 8

….persistent changes in airway structure (i.e. bronchodilator PFTs not showing the improvement it should) including fibrosis, epithelial injury, smooth muscle hypertrophy, etc. That’s why its important to control it to limit this from occurring

Question 9

Emerging therapeutic targets for asthma include ____, and the treatment for asthma is becoming more ____ due to the many varying mechanisms of pathogenesis

Answer 9

abnormal response of resident cells, patient specific

Question 10

Strongest predisposing factor to development of asthma

Answer 10

Atopy - propensity for IgE response to environmental antigen

Question 11

Medical term for an asthma “attack”

Answer 11

Asthma exacerbation

Question 12

Diagnosis of asthma (4)

Answer 12

• detailed medical history
• physical exam
• spirometry to demonstrate obstruction and assess reversibility
• additional studies to exclude other diagnoses

Question 13

Common history findings of asthma (5)

Answer 13

• family history of asthma especially mother
• cig smoke exposure
• coughs at night
• cough or wheeze after exercise
• colds take long time to resolve

Question 14

When (timing of respiratory cycle) is wheezing most often found on physical exam of asthmatic patient?

Answer 14

-End expiratory phase

Question 15

Physical exam findings of asthma (5)

Answer 15

• Wheezing end expiratory
• allergic shiners
• nasal drainage
• mucosal swelling
• nasal polyps

Question 16

Provocation test for diagnosis of asthma

Answer 16

Inducing asthma attack thru exercise or pharmacologic means (methylcholine commonly) to determine presence of asthma due to hyperreactive response to the testing compared to a normal patient who will not be very effected

Question 17

Differential diagnosis of asthma (5)

Answer 17

• COPD
• CHF
• ACEI induced cough
• PE
• foreign body obstruction

Question 18

Important principle: ____ of asthma determines initial treatment, and ____ determines changes in therapy throughout life

Answer 18

severity, control

Question 19

(4) categories of severity of asthma in patients 12 and older

Answer 19

• Intermittent
• Persistent mild
• persistent moderate
• persistent severe

Question 20

Barriers to treatment of asthma (3)

Answer 20

• failure to diagnose or inadequate education by clinician
• patient fails to take medication or avoid triggers
• insurance coverage

Question 21

Peak expiratory flow rate device (PEFR, peak flow)

Answer 21

-A device a patient will use that detects maximal rate a person can exhale during short maximal expiratory effort after full inspiration using a device on their own that correlates well with the % predicted value for FEVI, so this is a good monitor to detect changes for asthma control

Question 22

Asthma action plan

Answer 22

Usage of peak expiratory flow rate device and asthma medication to determine “zones” off baseline measures the patient falls in and needs to follow using proper individualized treatment protocol often using color coordination in order to control their asthma (example is adding a daily claritin if falling in the yellow zone)

Question 23

Stepwise therapy

Answer 23

Very important treatment principle of asthma to use recommendations for 3 different age groups with daily long term care for persistent treatment and therapy being altered as necessary when not controlled (stepped up) or when controlled for 2-3 month period (stepped down)

Question 24

Every asthma patient requires….

Answer 24

….short acting B agonist (SABA, albuterol typically) in the form of a rescue inhaler to treat acute symptoms, for some patients this is all they need

Question 25

In asthma, you will never prescribe solely a…

Answer 25

….long acting B agonist, only in combo with inhaled corticosteroids (alongside the SABA that all patients already get) in stepping up therapy, they have a black box warning of increased asthma related deaths and should be stepped down if controlled

Question 26

Rule of 2’s

Answer 26

Asthma treatment rule that if a patient is experiencing symptoms more often than 2 times per week during the day or twice a month at night, treatment regiment needs to be stepped up, while if there have been no exacerbations in the past 2 (or 3) months with no impairment with exercise or seasonal change, may step down

Question 27

Spacer

Answer 27

Chamber that is attached to the end of an inhaler to allow for greater delivery of medication

Question 28

Sampter’s triad

Answer 28

Triad that detects patient that undergoes asthma exacerbation within minutes of taking aspirin

• ASA sensitivity
• asthma
• nasal polyps

Question 29

SABA, LABA, and ICS are short for…

Answer 29

• Short acting B agonist
• Long acting B agonist
• Inhaled corticosteroids

Question 30

The majority of chronic asthma begins _____, 3/4 children _____ asthma by adulthood, new onset asthma in adults is often just _____

Answer 30

Before the age of 6, outgrow, undiagnosed childhood asthma

Question 31

Common asthma triggers (4)

Answer 31

• cold air
• exercise
• allergens
• fumes

Question 32

What measurement should demonstrate reversibility on spirometry when testing a bronchodilator response?

Answer 32

-FEVI should increase by >200mL and >12% baseline

Question 33

Patients who are considered high suspicion for asthma

Answer 33

3 or more wheezing episodes in past 12 months or 2 episodes in past 6, that required an oral corticosteroid, plus presence of 1 major or 2 minor criteria

Question 34

Daily long term care is recommended for all asthma’s that are classified as ____

Answer 34

Persistent

Question 35

Preferred long term control treatment across all age groups for asthma

Answer 35

Inhaled corticosteroids

Question 36

Chronic systemic corticosteroids should be reserved for _____ in children with asthma

Answer 36

severe cases only

Question 37

Cromolyn and nedocromil drug class

Answer 37

Mast cell stabilizer

Question 38

Examples of inhaled corticosteroids used in asthma (2)

Answer 38

• fluticasone (flovent)

- budesonide (pulmicort)

Question 39

Examples of long acting B2 agonists used to treat asthma (2)

Answer 39

• Advair (fluticasone/salmeterol)

- symbicort (budesonide/formoterol)

Question 40

Examples of leukotriene modifiers used to treat asthma (3)

Answer 40

• Singulair (montelukast)
• accolate (zafirlukast)
• zyflo (zileuton)