Asthma (Newman) Flashcards by Andrew Griffin

Curschmann spirals

characteristic finding in sputum or broncho-alveolar lavage specimens

extrusion of mucus plugs from sub-epithelial mucous gland ducts or bronchioles

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Charcot-leyden crystals

found in sputum or broncho-alveolar lavage specimens

composed of an eosinophil protein called galectin-10

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what happens to the sub-basement membrane in asthma

fibrosis due to type 1 and 3 collagen

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submucosal glands in asthma

increase in size and the number of goblet cells increase

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bronchial wall muscle in asthma

hypertrophy and hyperplastic

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airway remodeling may contribute to

chronic irreversible airway obstruction

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exampe of inhaled allergens

atopic allergens including
dust mites
cockroaches
seasonal pollens

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atopy is the ___ in asthma

strongest predisposing factor

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nonspecific precipitants (triggers)

exercise
URI
sinusitis
allergic rhinitis
aspiration
GER air pollution
meds (aspirin/NSAID)
occupation
obesity

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is chronic progressive cough common in asthma

not common

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do you commonly wake at night with breathlessness or wheezing with COPD

not commonly

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do the symptoms of COPD exhibit day to day variability

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with drug therapy would you expect FEV and FEV/FVC ratios to return to normal

never with significant disease but probably will with asthma

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key indicators of asthma

wheezing (esp in kids)

history of cough or recurrent wheeze, difficulty in breathing, and chest tightness

symptoms occur/worsen with exercise, viral infection, change in weather, strong emotion, menstrual cycle, or allergens

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key indicators of COPD

dyspnea that is progressive, worsens with exercise, persistent, or described by pt as increased effort to breathe, heaviness, air hunger, or gasping

chronic cough that may be intermittent or unproductive

chronic sputum production

history of exposure to risk factors especially tobacco smoke, occupational dust, and chemicals or smoke from home cooking and heating fuels

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be sure you check out the flow diagram for vocal cord dysfunction

the inspiration below the x axis is truncated

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ICS we should know

fluticasone
beclomethasone
budesonide

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leukotriene modifiers we should know

montelukast

zafirlukast

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5-lipoxygenase inhibitor we should know

zileuton

it inhibits leukotriene formation

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Respiratory arrest imminent, breathlessness

white at rest, mute

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Respiratory arrest imminent, talks in

silence

Respiratory arrest imminent, alertness

drowsy or confused

Respiratory arrest imminent, respiratory rate

> 30/min

Respiratory arrest imminent, body position

unable to recline

Respiratory arrest imminent, use of accessory muscles

paradoxical thoracoabdominal movement

Respiratory arrest imminent, wheezing

absent

Respiratory arrest imminent, pulse rate

bradycardia (compared to the 120 at severe respiratory distress)

Respiratory arrest imminent, pulsus paradoxus

absence suggests repiratory muscle fatigue

Respiratory arrest imminent PEF or FEV % of predicted

<25%

Respiratory arrest imminent PaO2

<60 with possible cyanosis

Respiratory arrest imminent, PCO2

>42

Respiratory arrest imminent saO2

<90%

peak flow meter green zone

80-100%

peak flow meter yellow zone

50-80%

peak flow meter red zone

<50%

initial asthma treatment

inhaled SABA up to two treatments 20 min apart of 2-6 puffs by MDI or nebulizer

Red flag Sudden onset of symptoms (wheeze) DDx

foreign body

coughing and choking when eating or drinking DDx with wheezing

oropharyngeal dysphagia with aspiration

poor growth and low BMI DDx with wheezing

cystic fibrosis, immunodeficiency

faimly history of sterile males with wheezing DDx

cystic fibrosis, immotile cilia syndrome

chronic rhinorrhea and recurrent sinus infection with wheezing DDx

cystic fibrosis, immotile cilia syndrome

Acute onset without asthma in teenager with wheezing DDx

vocal cord dysfunction

Chronic wet productive cough with wheezing DDx

bronchiectasis

more than 2 episodes of pneumonia with wheezing DDx

immunodeficiency

infants wheezing DDx

GERD congenital anomalies CF infection ciliary duskinesia immunodeficiency

preschool age wheezing DDx

asthma FBA CF GERD infectious/postinfectious cause immunodeficiency congenital anomaly

school age wheezing DDx

asthma vocal cord dysfunction CF infectious/postinfectious causes immunodeficiency A1 antitrypsin deficiency FBA

diagnosing asthma in kids younger than 2

difficult and requires repeated wheezing episodes with no other identifiable cause family Hx of atopy and response to albuterol is helpful

education includes

treatment goals inhaler technique elimination of triggers asthma action plan

follow up visit 6 step flow

assess asthma control review action plan identify asthma triggers and plan for elimination adjust medication as needed according to step model schedule f/u parents and patient monitor asthma symptoms

approach to asthma

make diagnosis classify severity prepare initial treatment plan when stable proceed to maintenance plan develop an asthma action plan monitor with periodic eval with seasonal change in classification and changes with age