asthma_brainscape_cards_comprehensive Flashcards
How many people worldwide are affected by asthma?
~300 million
What percentage of the U.S. population had asthma as of 2012?
8% (~20 million people)
What is the global prevalence range of asthma?
5-16%
At what age can asthma occur?
Any age (childhood > adulthood)
How much does the U.S. spend annually on adult asthma?
$18 billion
How many physician office visits are related to asthma annually in the U.S.?
~10.5 million
How many ER visits are related to asthma annually in the U.S.?
~2 million
How many asthma-related deaths occur annually in the U.S.?
4000 deaths
What characterizes asthma’s pathophysiology?
Chronic and recurrent bronchial hyperresponsiveness and obstruction
What cells and mediators are involved in asthma inflammation?
CD4+ T cells, eosinophils, IgE, T-helper cells (TH2)
What is the role of IgE in asthma?
Regulates mast cell degranulation, leading to bronchospasm after antigen exposure
Is asthma inflammation reversible?
Yes, inflammation and bronchial constriction are reversible
What happens with recurrent airway inflammation in asthma?
Can lead to airway remodeling with permanent lung changes (mucosal cell hyperplasia, endothelial cell injury, subepithelial fibrosis)
What occupational exposures are risk factors for asthma?
Smoke, dust, fumes, dust-mites, pollen, dander, cold exposure, metals
What is the impact of obesity on asthma risk?
BMI > 30 kg/m2 increases incidence of asthma by 2-3x
What are the main risk factors for asthma?
Occupational exposure, smoking, obesity, allergic rhinitis, family history
What are common signs and symptoms of asthma?
Shortness of breath, cough (worse at night), wheezing, chest tightness
When does asthma-related wheezing most commonly occur?
More commonly during expiration
Does the absence of wheezing exclude asthma?
No, it does not exclude the diagnosis
What are severe symptoms indicating respiratory failure in asthma?
Prolonged expirations, increased work of breathing, retractions, lack of air movement, decreased breath sounds
What historical points are important for hospitalized asthma patients?
Acute vs chronic symptoms, medication compliance, previous hospitalizations, intubation history, triggers
What are risk factors for asthma-related death?
Previous severe exacerbation, multiple hospitalizations, high SABA usage, comorbidities, low socioeconomic status, psychosocial problems, psychiatric disease, illicit drug use
What conditions are in the differential diagnosis of asthma in infants and children?
Allergic rhinitis, sinusitis, foreign body, viral bronchiolitis, cystic fibrosis, heart disease
What conditions are in the differential diagnosis of asthma in adults?
COPD, CHF, pulmonary embolism, tumors, medication-induced (ACE inhibitors), vocal cord dysfunction
What is the gold standard diagnostic test for asthma?
Spirometry demonstrating reversibility of airflow obstruction with bronchodilator
What spirometry result indicates bronchodilator reversibility in asthma?
Improvement of ≥ 12% & 200 mL in FEV1 after treatment
What does a positive methacholine test indicate in asthma?
A decrease in FEV1 by 20% with ≤ 8 mg/dl of methacholine
What is the indication for using fractional exhaled nitric oxide (FeNO) in asthma?
To assist in diagnosis and monitor eosinophilic inflammation, especially in allergic asthma
What findings on chest X-ray might you see during an asthma exacerbation?
Typically normal, but can show hyperinflation, bronchial wall thickening, hilar prominence
What is the initial treatment for a mild to moderate asthma exacerbation?
Oxygen if needed (SaO2 ≥ 90%), albuterol (up to 3 doses in the first hour), corticosteroids if no immediate response to SABA
What is the goal SaO2 during severe asthma exacerbation treatment?
SaO2 ≥ 90%
What are the treatment options for severe asthma exacerbation?
Oxygen, albuterol, corticosteroids, consider adjunctive treatments (ipratropium, magnesium, heliox, non-invasive ventilation)
What is the first-line treatment for intermittent asthma?
PRN SABA or ICS-Formoterol
What is the preferred treatment for severe persistent asthma (Step 6)?
High Dose ICS + LABA + oral steroid (prednisone)
What is the treatment approach for exercise-induced asthma?
Albuterol 15-30 min prior to exercise, montelukast (second-line), cromolyn sodium (alternative)
What is the mechanism of omalizumab in asthma treatment?
Monoclonal antibody that prevents binding of IgE to receptors on basophils and mast cells
What is the benefit of mepolizumab in asthma treatment?
Reduces ER visits and hospitalizations, particularly in patients with high blood eosinophil counts
What is the mechanism of dupilumab in asthma treatment?
Anti-IL-4 receptor alpha-subunit monoclonal antibody that blocks IL-4 and IL-13 signaling in Th2 inflammation
What percentage of asthma patients also have GERD?
20-80%
What is the impact of pregnancy on asthma?
Symptoms worsen in 1/3 of patients, especially between 13-24 weeks
What are the risks of poorly controlled asthma during pregnancy?
Preeclampsia, prematurity, decreased growth of child, cesarean delivery
What percentage of patients with asthma experience exercise-induced asthma?
> 90%
What are the diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA)?
(+) aspergillus skin test, increased IgE and/or IgG to Aspergillus, central bronchiectasis
What is occupational asthma?
Asthma induced by workplace exposure in a patient without preexisting asthma
