B4-032 Asthma Flashcards
the profound healthcare costs of asthma stem from
acute management with urgent cares and ERs
coughing in asthma is typically at what times of day?
early morning or night
what type of cell is predominate during acute exacerbation of asthma?
neutrophils
mast cells and eosinophils also present
associated with […] that is often reversible with/without treatment
variable airflow obstruction
association of molecular mechanisms to certain phenotypes
endotypes
treatment targeted at a patient’s specific endotype
precision medicine
T2- High Phenotypes
3
- early onset allergic asthma
- late onset eosinophilic asthma
- aspirin exacerbated respiratory disease
- onsets before age 12
- strong allergic and family hx
- positive allergen skin tests and IgE
early onset allergic asthma
- adult onset
- steroid resistant
- comorbid chronic rhinosinusitis and nasal polyposis
- blood/sputum eosinophilia
- high IL5, IL13, IgE, and exhaled NO
late onset eosinophilic asthma
- asthma
- chronic rhinosinusitis with nasal polyposis
- acute respiratory tract reactions to ASA or COX-1 NSAIDs
AERD
expiratory wheeze
asthma
stridor is associated with
vocal cord dysfunction
what test diagnosis asthma?
no single test
severity of asthma is determined by
2 things
impairment
risk
chronic therapies for asthma
5
- trigger avoidance
- inhaled corticosteroids
- leukotriene inhibitors
- biologics
- allergy shots
single steps to reduce exposure are generally
uneffective
standard of care for treatment of asthma
inhaled corticosteroids
once the symptoms are well controlled
deescalatate steroids
rule of 1/3s
pertains to symptoms during pregnancy
1/3 no symptoms
1/3 get worse
1/3 get better
risk associated with poorly controlled asthma in pregnancy
4
- increased perinatal mortality
- low birth weight
- preeclampsia
- preterm birth
the move to precision based medicine puts what treatment at the forefront for severe asthma?
biologics
does wheezing have to be present for a diagnosis of asthma?
no
symptoms of asthma
- wheezing
- coughing
- recurrent bronchitis
- shortness of breath
common triggers
- exposure to irritants
- infection
- weather changes
- anxiety
- reflux disease
identifying and recognizing […] is a key component of well controlled asthma
triggers
can acid reflux contribute to asthma symptoms?
yes if poorly controlled
are bronchodilators meant for daily use?
no
help control the airway inflammation associated with asthma and prevent symptoms
long term controller medications
open airways quickly so that more air can flow though
quick relief bronchodilators
airway remodeling is caused by
permanent scarring due to long term inflammation
for best results, the optimal patient for pulmonary function testing is
cooperative and able to understand instructions and give forceful respiratory effort
benefits of inhaled corticosteroids
- improved lung function
- reduced risk of asthma attacks
- decrease airway hyperresponsiveness
- improve symptoms
key elements of self-management of asthma
- recognizing presence and severity of an attack
- knowing when to get help
- instensifying therapy
step 5 therapy recommends
increasing to high dose inhaled steroid
step 4-6 therapy recommends considering
allergy immunotherapy
or
Omalizumab (IgE inhibitor)
samter’s triad
asthma, nasal polyps, aspirin sensitivity
mainstay of asthma treatment
inhaled corticosteroids
beclomethasone is an
inhaled corticosteroid
comolyn sodium is a
mast cell stabilizer
can be useful in addition to inhaled corticosteroids
ecspecially extrinisic allergic asthma
leukotriene inhibitor
in patients with difficult to control asthma already on inhaled corticosteroids and luekotriene inhibitos, consider
ipratropium bromide
IL-5 inhibitors are used to treat
severe persistent asthma
top three causes of cough
- asthma
- GERD
- postnasal drip
preferred treatment for patients with moderate persistent asthma
ICS/formoterol for daily and rescue therapy
allergen mitigation is not recommended unless
patient has historical or allergen testing of indoor allergens
individuals with asthma of any severity should be assessed for
allergens at home/work, symptoms on exposure, and allergy testing
if none identified, no need for allergen mitigation
