Asthma (Newman) Flashcards

1
Q

What is asthma?

A
  • episodic or chronic Sx of airflow obstruction - reversibility of airflow obstruction, either spontaneously or following broncho dilator therapy
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2
Q

How is asthma diagnosed?

A
  • limitation of airflow on pulmonary function testing OR - positive broncho-provocation challenge (methacholine challenge)
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3
Q

Clinical Sx of asthma (5)

A
  • cough - wheezing - chest tightness - prolonged exhalation - shortness of breath
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4
Q

Chronic asthmatic airway findings (5)

A

1) thickening of airway wall 2) sub-basement membrane fibrosis 3) increased vascularity 4) increase size of submucosal glands and number of goblet cells 5) hypertrophy of bronchial wall muscle

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5
Q

Asthmatic airway during acute attack

A
  • bronchiole wall inflamed and thickened - tightened smooth muscle
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6
Q

How can exposure to allergens trigger asthma?

A

allergen activates TH2 cells to activate B cells which recruit mast cells (histamine) to activate eosinophils

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7
Q

Two findings seen in prolonged status asthmaticus

A

1) curschmann spirals (mucus plugs) 2) charcot-leyden crystals (eosinophil protein galectin-10)

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8
Q

Strongest predisposing factor for asthma

A
  • atopy (heightened response with exposure to inhaled allergens –> dust mites, cockroaches, seasonal pollens)
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9
Q

Difference between asthma and COPD

A

with asthma: - FEV1 and FEV1/FVC ratio generally return to normal with drug therapy - Symptoms occur/worsen at night and wake up patient

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10
Q

Asthma Flow volume loop pre and post bronchodilator

A
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11
Q

Flow volume loop with vocal cord dysfunction

A

usually with tall, thin, young women who are SOB with exertion

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12
Q

First line quick relief asthma medication

A

Beta 2 agonists

  • SABA (albuterol or levalbuterol)
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13
Q

Preferred Step 2 asthma treatment

A

Low-dose inhaled corticosteroid

  • fluticasone
  • beclomethasone
  • budesonide
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14
Q

leukotriene modifier drugs

A

Leukotrinene receptor antagonists

  • montelukast
  • zafirlukast

5-lipoxygenase inhibitor

  • Zileuton
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15
Q

Where are leukotrienes released from?

A

mast cells

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16
Q

Symtoms (3) respiratory arrest is imminent

A

breathlessness while at rest

silent

drowsy or confused

17
Q

Signs (6) respiratory arrest is imminent

A

RR >30/min

unable to recline

paradoxical thoracoabdominal movement

absent wheezes

bradycardia

absence of pulsus paradoxus = resp muscle fatigue

18
Q

Asthma classification of child that uses SABA a couple times a week, maybe before exercise or at night

A

intermittent

19
Q

classification of asthma with 2 or greater attacks in past 6-12 months requiring systemic steroids

A

persistent

20
Q

Patient uses SABA PRN, but asthma status gets worse with seasonal changes. What is the next step?

A

Add low dose inhaled corticosteroid

21
Q

Stepwise approach for asthma therapy (first 4 steps in age 0-4)

A

1) SABA as needed
2) low-dose ICS
3) medium-dose ICS
4) medium-dose ICS and LABA -OR- montelukast

*ALSO see specialist at step 4

22
Q

how frequently can a SABA be taken?

A

up to 2 treatments, 20 minutes apart of 2-6 puffs

23
Q

Levels of asthma action plan

A

Green zone: child is well with no asthma Sx even during play

Yellow zone: child is not well and has asthma sx

Red zone: child feels awful with dangerous Sx

24
Q

Describe well controlled asthma (5 things)

A

1) Sxs less than 2 days per week
2) Awakened at night less than 2x per month
3) no interference with activity
4) SABA use 2 or less days per week
5) FEV1 >80% of predicted

25
Four parts of parent education with asthma
1) treatment goals 2) inhaler technique 3) elimination of triggers 4) asthma action plan
26
Classify moderate persistent asthma
daily symptoms wake up \>1x/week but not nightly SABA use daily some limitation with normal activity
27
classify severe persistent asthma
symptoms throughout the day awakened 7x/week SABA use several x per day extremely limited normal activity
28
classify mild persistent asthma
symptoms \>2 days/week but not daily nighttime awakenings 3-4x/month SABA use \>2 days/week, but no more than 1x per day minor limitation of normal activity
29
Treatment of acute asthma attack
O2 albuterol steroids