Bronchial Asthma Flashcards
Physiologic abnormalities in Bronchial Asthma
Airway hyperresponsiveness
Chronic airway inflammation
Variable expiratory outflow obstruction
Typical symptoms of Asthma
Wheezes
Shortness of breath
Chest tightness
Cough
***symptoms worse at night
Defined as cough with hyperactive airway
Cough variant asthma
Risk Factors for Asthma
Atopy - Major risk factor
Overweight
Family history
Exposure to allergens
Most common allergen trigger
Dust mite:
Dermatophagoides sp.
What is the most accurate test to confirm the diagnosis of asthma?
Pulmonary Function Tests or Spirometry
What is the most accurate test for asymptomatic patients in the diagnosis of asthma?
Methacholine/Histamine stimulation test
**setting of normal PFT
Triggers
Allergens
Exercise
Laughter
Cold air
Obstructive pattern in spirometry for asthma:
FEV1/FVC < 0.75-0.8
Reversibility criteria for variable expiratory airflow limitation:
- Reduced FEV1 that increases by 12% or atleast 200mL from baseline post-bronchodilator
- Reduced FEV1 that increases by 12% or atleast 200mL after 2-4 weeks of steroid trial (30-40mg prednisone or prednisolone)
- Decrease in FEV1 by 20% with Methacholine or Histamine stimulation test
Test for Airway Hyperresponsiveness
Methacholine or Histamine Stimulation Test
Flow-Volume Loop in Asthma shows:
Reduced PEF
Scalloped appearance
Relievers
ICS+Formoterol
SABA
SAMA
Methylxanthine
IV Corticosteroids for acute attacks
Controllers
ICS
LABA with ICS
Leukotriene Antagonist
Mast Cell stabilizers
Anti-IgE
Management for Acute Severe Attack
Treatment:
SABA
SAMA
IV Corticosteroids
O2
Mg SO4
Intubation**
Tests:
PEF
CXR
ABG
Impending Respiratory Failure in ABG
Normal or decreased PCO2
Asthma in Pregnancy
SABA
SAMA - Theophylline
ICS
Decrease in mortality among asthmatics
ICS
Non-invasive test hsed to demonstrate eosinophilic airways
Fractional exhaled NO (FeNO)
Most common side effects of B-Agonists
Tremors
Palpitations
Asymptomatic hypokalemia in elderly
Most common side effects of Muscarinic Antagonists
Dry mouth
Glaucona, urinary retention (elderly)
Local side effects of ICS
Hoarseness
Oral candidiasis
Most common side effects of Theophylline
Nausea
Tremors
Palpitations
How to prevent exercise-induced asthma
Regular ICS use
Drugs contraindicated in asthmatics
Aspirin
Beta blockers
How to reduce local side effects of ICS
Large volume spacers
Triad for aspirin sensitivity, recurrent nasal polyps, asthma
Samter triad
