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RET1293 > Ch. 14 - Asthma > Flashcards

Ch. 14 - Asthma Flashcards

1
Q

Asthma characterized by ________________.

A

Chronic airway inflammation

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2
Q

Asthma is defined by the history of respiratory symptoms such as ________________________.

A
  • Wheeze
  • SOB
  • Chest tightness
  • Cough
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3
Q

Both symptoms and airflow limitation typically vary over time and ___________.

A

Intensity

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4
Q

The variations in symptoms and airflow limitation are commonly triggered by factors like:

A
  • Exercise
  • Allergen or irritant exposure
  • Change in weather
  • Viral respiratory infection
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5
Q

Asthma episodes are usually associated with what?

A

Airway hyperresponsiveness to direct and indirect stimuli and chronic airway inflammation

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6
Q

Asthma is described as a heterogenous disease that commonly has a set of observable characteristics that result from the interaction of the patient’s genotype with the environment - What is the called?

A

Asthma phenotype

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7
Q

Patients with allergic asthma is usually respond well to therapy with ____________.

A

Inhaled corticosteroids

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8
Q

Before treatment, the sputum of patients with allergic asthma often reveals ________________.

A

Eosinophilic airway limitation

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9
Q

What are the cellular characteristics of the sputum in nonallergic asthma?

A

Neutrophilic, eosinophilic or only a few inflammatory cells

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10
Q

Does patients with nonallergic asthma typically respond well to ICS therapy?

A

No.

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11
Q

What type of asthma typically requires higher doses of ICS therapy and are relatively resistant to corticosteroid therapy?

A

Late-onset asthma

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12
Q

Where is asthma with prominent respiratory symptoms and little eosinophilic airway inflammation commonly seen?

A

Obese patients (body mass index greater than 30 kg/m2)

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13
Q

The first evidence-based asthma guidelines were published in 1991 by ______________________.

A

National Asthma Education and Prevention Program

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14
Q

Asthma guidelines are structured around the following four components of care:

A
  1. Assessment and monitoring of asthma
  2. Patient education
  3. Control of factors contributing to asthma severity
  4. Treatment medications
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15
Q

What is the role of GINA?

A

To collect the most current scientific evidence associated with asthma care and transfer the information into user-friendly format

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16
Q

Asthma is described as a lung disorder characterized by:

A
  1. Reversible bronchial smooth muscle constriction
  2. Airway inflammation
  3. Increased airway responsiveness to an assortment of stimuli
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16
Q

During an asthma attack, what happens to the smooth muscles surrounding the small airways?

A

They constrict

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17
Q

The airway mucosa becomes infiltrated with eosinophils and other inflammatory cells, which in turn causes ________________.

A

Airway inflammation and mucosal edema

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18
Q

Mircoscopic crystals, called _______________ are formed from the breakdown of eosinophils in patients with allergic asthma.

A

Charcot-Leyden crystals

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19
Q

What are the major pathologic or structural changes observe during an asthma episode?

A
  1. Smooth muscle constriction of bronchial airways
  2. Excessive production of thick, whitish bronchial secretions
  3. Mucous plugging
  4. Hyperinflation of alveoli (air trapping)
  5. In severe cases, atelectasis caused by mucous plugging
  6. Bronchial wall inflammation leading to fibrosis
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20
Q

The WHO estimates that ___________ people world wide suffer from asthma.

A

235 million

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21
Q

If chronic inflammation develops over time, these anatomic alterations become irreversible, resulting in what?

A

Loss of airway caliber

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22
Q

Crystals that are slender and pointed at both ends and have a pair of hexagonal pyramids jointed at the bases

A

Charcot-Leyden crystals

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23
Q

When the cilia is damaged, and the basement membrane of mucosa may become thicker than normal (fibrosis). What is the process called?

A

Remodeling

24
Q

What is the remarkable finding of bronchial asthma?

A

Anatomic alterations of the lungs that occur during an attack ares completely absent between asthma episodes and that remodeling does not occur to any great extent.

25
Q

Before the age of _______, the prevalence of asthma is nearly two times greater in boys than girls.

A

14

26
Q

What are some host factors for asthma?

A
  • Sex
  • Obesity
  • Genetics
27
Q

What are some environmental factors for asthma?

A
  • Allergens
    Indoor: domestic mites, furred animals, cockraoch allergen, fungi, molds, yeast
  • Infections (primarily viral)
  • Tobacco smoke
  • Outdoor/indoor pollution
  • Diet
28
Q

__________________ is defined as asthma caused by exposure to an agent encountered in the work environment.

A

Occupational asthma

29
Q

__________________ is defined as asthma caused by exposure to an agent encountered in the work environment.

A

Occupational asthma

30
Q

It is estimate that occupational sensitizers cause about ______% of cases of asthma among adults of working age.

A

15

31
Q

Although bacterial infections may cause asthma, ____________________ are more likely to contribute to asthma.

A

Viral upper and lower airway infections

32
Q

It is estimated that ______% of children with RSV infections will continue to wheeze or have asthma into later childhood.

A

40%

33
Q

Charcot-Leyden crystals are formed from the ___________________.

A

The breakdown of eosinophils in patients with allergic asthma

34
Q

When do the symptoms of perimenstrual asthma peak?

A

2-3 days before menstruation begins

35
Q

What is the normal FeNO in adults?

A

Less than 25 ppb

35
Q

What is the normal FeNO in children?

A

Less than 20 ppb

36
Q

FeNo levels rise with _______________.

A

Eosinophilic airway inflammation

37
Q

What are the major alterations of the lungs associated with an asthma episode?

A
  • Bronchospasm
  • Excessive bronchial secretions
38
Q

What are some radiologic findings of asthma?

A
  • Increased AP diameter
  • Translucent (dark) lung field
  • Depressed or flattened diaphragm
39
Q

What is the ABG classification of a mild to moderate asthma episode?

A

Acute alveolar hyperventilation with hypoxemia

40
Q

What is the ABG classification of a severe asthma episode?

A

Acute Ventilatory Failure with hypoxemia

41
Q

When an asthma episode produces severe alveolar air trapping and hyperinflation, ___________ is a classic manifestation.

A

Pulsus paradoxus

42
Q

Define pulsus paradoxus.

A

Systolic blood pressure that is more than 10 mmHg on inspiration than on expiration.

43
Q

Pulsus paradoxus during an asthma attack is believed to be caused by what?

A

Major intrapleural pressure swings that occur during inspiration and expiration.

44
Q

What are some chest assessment findings in asthma?

A
  • Expiratory prolongation
  • Decrease tactile fremitus and vocal fremitus
  • Hyperresonant percussion note
  • Diminished breath sounds
  • Wheezing
  • Crackles
45
Q

What are GINAs long-term goals for asthma management?

A

Symptom control and risk reduction for future exacerbation

46
Q

Before considering a step up in a patient’s treatment what should you do?

A

Check for common problems such as poor inhaler technique, poor adherence and environmental exposure to allergic allergens

47
Q

When the control of asthma symptoms have been maintained for at least _______________, ICS doses should be titrated to the minimum dose that will maintain good symptom control and minimize exacerbation risks and potential side effects.

A

3 months

48
Q

In addition to a SABA, what would you give a patin who experiences uncomfortable side effects from ICSs or has concurrent allergic rhinitis?

A

Leukotriene receptor antagonists

49
Q

What type of patients is bronchial thermoplasty indicated for?

A

Patients with severe persistent asthma who are 18+ and whose asthma is not well controlled with long-acting beta-agonists and ICSs.

50
Q

Explain what medication to give if in the YELLOW zone

A

Albuterol Sulfate 90 mcg MDI 4 puffs w/ spacer every 4 hours

If getting better, 4 puffs every 6 hours.

51
Q

Explain what medication to give if in the RED zone

A

Albuterol Sulfate 90 mcg MDI 6 puffs w/ spacer NOW
Repeat every 20 minutes two more times
If getting worse, HOSPITAL
If getting better, make appt with doctor and continue albuterol every 4 hours
Start prednisone now as instructed by doctor if you have it on hand.

52
Q

An asthma exacerbation is characterized by _____________________.

A

A progressive increase in symptoms of SOB, cough, wheezing, chest tightness and progressive decrease in lung function

53
Q

Significant evidence indicates GERD is more common patients with ____________ than the general population.

A

OSA and asthma

54
Q

Continuous nebulization of albuterol is often used in the management of status asthamaticus to prevent __________________.

A

Acute ventilatory failure

55
Q

Hypoxemia that develops in asthma is usually caused by what?

A

V/Q mismatch and shunt-like effect associated with bronchospasm and increased airway secretions

56
Q

_________ is defined a severe asthma episode that does not respond to conventional pharmacologic therapy.

A

Status asthmaticus

RET1293 (10 decks)

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