Asthma Lecture Powerpoint Flashcards
____ is the most common chronic illness in children
Asthma
____ is very important to proper management of asthma
Education
Asthma is more common in ____ women than men, ____ than adults, and ____ race
How has the rate of asthma changed in the past 20 years?
- adult, children, african americans
- It has nearly doubled
Obstructive asthma pathophysiology
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
Factors that play a role in causing of asthma (4)
- viral infection (RSV under age 1)
- genetics
- allergens
- poor air quality
Hygiene hypothesis
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.
Asthma is better treated if ____ can be identified and avoided
Triggers
In uncontrolled chronic asthma, can see….
….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
Emerging therapeutic targets for asthma include ____, and the treatment for asthma is becoming more ____ due to the many varying mechanisms of pathogenesis
abnormal response of resident cells, patient specific
Strongest predisposing factor to development of asthma
Atopy - propensity for IgE response to environmental antigen
Medical term for an asthma “attack”
Asthma exacerbation
Diagnosis of asthma (4)
- detailed medical history
- physical exam
- spirometry to demonstrate obstruction and assess reversibility
- additional studies to exclude other diagnoses
Common history findings of asthma (5)
- family history of asthma especially mother
- cig smoke exposure
- coughs at night
- cough or wheeze after exercise
- colds take long time to resolve
When (timing of respiratory cycle) is wheezing most often found on physical exam of asthmatic patient?
-End expiratory phase
Physical exam findings of asthma (5)
- Wheezing end expiratory
- allergic shiners
- nasal drainage
- mucosal swelling
- nasal polyps
Provocation test for diagnosis of asthma
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
Differential diagnosis of asthma (5)
- COPD
- CHF
- ACEI induced cough
- PE
- foreign body obstruction
Important principle: ____ of asthma determines initial treatment, and ____ determines changes in therapy throughout life
severity, control
(4) categories of severity of asthma in patients 12 and older
- Intermittent
- Persistent mild
- persistent moderate
- persistent severe
Barriers to treatment of asthma (3)
- failure to diagnose or inadequate education by clinician
- patient fails to take medication or avoid triggers
- insurance coverage
Peak expiratory flow rate device (PEFR, peak flow)
-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
Asthma action plan
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)
Stepwise therapy
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)
Every asthma patient requires….
….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
In asthma, you will never prescribe solely a…
….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
Rule of 2’s
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
Spacer
Chamber that is attached to the end of an inhaler to allow for greater delivery of medication
Sampter’s triad
Triad that detects patient that undergoes asthma exacerbation within minutes of taking aspirin
- ASA sensitivity
- asthma
- nasal polyps
SABA, LABA, and ICS are short for…
- Short acting B agonist
- Long acting B agonist
- Inhaled corticosteroids
The majority of chronic asthma begins _____, 3/4 children _____ asthma by adulthood, new onset asthma in adults is often just _____
Before the age of 6, outgrow, undiagnosed childhood asthma
Common asthma triggers (4)
- cold air
- exercise
- allergens
- fumes
What measurement should demonstrate reversibility on spirometry when testing a bronchodilator response?
-FEVI should increase by >200mL and >12% baseline
Patients who are considered high suspicion for asthma
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
Daily long term care is recommended for all asthma’s that are classified as ____
Persistent
Preferred long term control treatment across all age groups for asthma
Inhaled corticosteroids
Chronic systemic corticosteroids should be reserved for _____ in children with asthma
severe cases only
Cromolyn and nedocromil drug class
Mast cell stabilizer
Examples of inhaled corticosteroids used in asthma (2)
- fluticasone (flovent)
- budesonide (pulmicort)
Examples of long acting B2 agonists used to treat asthma (2)
- Advair (fluticasone/salmeterol)
- symbicort (budesonide/formoterol)
Examples of leukotriene modifiers used to treat asthma (3)
- Singulair (montelukast)
- accolate (zafirlukast)
- zyflo (zileuton)
