Asthma Review Flashcards
1
Q
What is asthma?
A
chronic inflammatory disease of airways with:
- airway obstruction that may or may not be reversible either spontaneously or with meds
- airway inflammation caused by many cellular components
- increased ariway hyper responsiveness
- airway remodeling
2
Q
Development of asthma?
A
- genetics + environmental factors lead to airway inflammation and then to bronchoconstriction and then manifest as asthma sxs
3
Q
Asthma PP?
A
- inhaled trigger leads to release of histamine leukotrienes from mast cells which lead to bronchospasm and this then leads to late asthmatic response and chronic inflammation
- this leads to neural and vascular effects, there is recruitment and activation of inflammatory cells (cytokines) which cause mast cells to release histamine leukotrienes - leading to bronchospasm
4
Q
Common allergens and irritants of asthma? other triggers?
A
- allergens: dust mites, pet dander, pollen, rodents, mold, natural oils
- irritants: smoke, strong fumes, pollutions, ozone, chemicals, petroleum, VOCs
other triggers:
-URI - rhinovirus
-tobacco and other smoke exposure
-exercise
-cold air
-GERD
-chronic sinus disease
5
Q
What is more prevalent: GERD or asthma?
A
- GERD
- may be present in up to 70% of asthma pts
- physiology of asthma and meds for asthma may increase risk for GERD
- GERD may worsen asthma through direct irritation or nervous system reaction
6
Q
Correlation b/t NSAIDs and asthma?
A
- up to 20% of adult asthmatics may experience asthma sxs after ingestion of aspirin or NSAIDS
- rare in kids
- usual presentation: adult with chronic rhinitis, nasal polyps, asthma
- pts usually present with malaise, rhinnorhea, bronchospasm, productive cough, and occasionally angioedema within 20 min to 3 hrs of aspirin or NSAID ingestion
7
Q
When should you suspect asthma?
A
- persistent cough
- recurrent pneumonia
- responds to albuterol
8
Q
Impt findings in hx of asthma pt?
A
- recurrent cough, wheeze, SOB esp at night or with exercise
- improvement with bronchodilator
- clear triggers: exercise, cold air, allergens, colds
- PMH: allergic child (atopic dermatitis, allergic rhinitis)
- family hx: esp maternal
9
Q
positive asthma sxs during physical?
A
- wheezing: inspiratory, expiratory or both
- could have clear lung exam
- tripod breathing
- tachypnea
- hypoxemia
- dyspnea
- retractions
- poor aeration
- prolonged I:E ratio
- think of other things if there is clubbing or crackles
10
Q
DDx of asthma?
A
upper/central airways:
- allergic rhinitis/ sinusitis
- fb
- vascular ring or sling
- laryngo/tracheo/bronchomalacia
- vocal cord dysfxn
lower airways:
- bronchiolitis
- CF
- bronchopulmonary dysplasia
- heart disease
- aspiration/GERD
- asthma
11
Q
Simple goals of tx ped asthma pt?
A
- sleep: prevent chronic coughing, asthma sxs, and asthma exacerbations during day and night
- learn: eliminate missed school days
- play: maintain normal activity levels
12
Q
Classification of intermittent asthma in peds?
A
- less than 2 days/week sxs
- no nighttime awakenings
- less than 2 days a week using SABA for sx control
- no interference with normal activity
- 0-1/year requiring oral steroids
- in kids 5-11: normal FEV1 b/t exacerbations, FEV1 greater than 80% of predicted and FEV1/FCV is greater than 85%
13
Q
Mild persistent asthma in peds?
A
- more than 2 days/week of sxs but not daily
- 1-2x a month nighttime awakenings
- use SABA more than 2 days a week but not daily
- minor limitation with normal activity
- more than 2 exacerbations in 6 months requiring oral steroids
- 5-11:
FEV1= greater than 80% predicted
FEV1/FVC= greater than 80%
14
Q
Moderate persistent asthma in peds?
A
- daily sxs
- 3-4x a month nightly awakenings
- daily use of sx SABA use
- some limitation with normal activity
- more than 2 exacerbations in 6 months reqring oral steroids
- 5-11:
FEV1= 60-80% predicted
FEV1/FVC= 75-80%
15
Q
Severe persistent asthma in peds?
A
- sxs throughout the day
- more than 1 nighttimes awakening within a week
- seveal times a day of SABA sx relief
- extremely limited normal activity
- more than 2 exacerbations in 6 months requiring oral steroids
- ages 5-11:
FEV: less than 60% predicted
FEV/FVC= less than 75%
