ch. 15 Flashcards
In asthma the bronchi are hyperactive to stimuli increasing the production of…
Immunoglobulin E(IgE), mast cell degranulation and inflammatory-mediators.
Most common spirometry tests used to diagnose and manage asthma?
FVC(forced viral capacity) FEV1 and FEV1/ FEV%
Reversibility or indicator of airway responsiveness to bronchodilator is defined as?
Increase in FEV1 and FVC of 12%
What additional tests are used to differentiate asthma from childhood diseases?
Broncoprovocation challenge, chest radiograph, allergy testing, sputum, blood and urine testing.
What test uses methacholine or mannitol inhalation to induce hyperactivity of small airways to see a reduction in FEV1
Broncoprovocation challenge test
What % of reduction of FEV1 is considered positive for the broncoprovocation test?
20% reduction of FEV1
Exercise tolerance tests are performed over 5 to 8 minutes and heart rate is increased to 85% of predicted. What decline % of FEV1 shows a positive response?
Decline of 15% of FEV1
Exercise test is more or less sensitive to bronchial hyper responsiveness?
Less sensitive
Asthma expert panel report(EPR-3) divides asthma assessment and treatment into how many ranges?
3: 0-4 years, 5-11 years, 12 years or older.
Asthma is categorized into two domains, which are?
Impairment and risk
Four classifications of asthma
Intermittent, mild persistent, moderate persistent, and severe.
Impairment for intermittent asthma
Symptoms<2 days a week, 0 night time awakenings, Saba for symptoms _< 2 days a week, no interference with normal activity. 0-1 exacerbations requiring oral steroids.
Mild persistent asthma classification
> 2 days/week but not daily
Nighttime awakenings 1-2 times a month.
Saba for symptoms > 2 days a week but not daily.
Interference with normal activity- minor
exacerbations in 6 months requiring oral steroids or 4 wheezing episodes per year.
Moderate persistent asthma classification
Symptoms daily Nighttime awakenings- 3-4 times a month Saba for symptoms daily Some limitation to normal activity > 2 exacerbations in 6 months requiring oral steroids or 4 wheezing episodes per year.
Sever asthma classification
Symptoms: throughout the day
Nighttime awakenings: > 1 time a week
Saba for symptoms: several times per day
Extremely limited activity
> 2 exacerbations in 6 months requiring oral steroids or 4 wheezing episodes per year
Detailed history and physical is useful in
Differentiating asthma from other diseases.
Decrease pharmacological therapy if asthma control improves and sustains for
3 months
What is the key element for asthma home management?
Education
Peak flow monitor is not as sensitive as the FEV1 to changes in?
Diameter of small airways.
Used to measure how much air can move out of the airway with a blast of exhalation.
Peak flow meter
Step 1 asthma
Saba prn
Step 2 asthma
Low dose ics can use chromolyn or montelukast
Step 3 asthma
Medium dose ics
Step 4 asthma
Medium dose ics+ LABA or montelukast
Step 6 asthma control
High dose ics+ LABA or montelukast
Oral steroids
Managements of asthma 4 components
components:
(1)Assess and monitor asthma severity and control
(2)Partner with patients and families to educate them on their asthma plan of care
(3)Control environmental factors and comorbid conditions that trigger asthma exacerbation
(4)Prescribe appropriate medications for treatment of asthma
–Assess and monitor asthma severity and control
Quick relief rescue
–SABAs
–3–5 minutes onset
–4–6 hours effect
–Normally not on a regular basis
Asthma management in the hospital
•Poor response to therapy within the first few hours of treatment (2–4) in the ED or a repeat visit within 24 hours of discharge home from the ED
Cystic Fibrosis
- Life-limiting autosomal recessive disorder
* Affects approximately 80,000 individuals worldwide
Etiology CF
–Single gene defect on chromosome 7
–Carriers have few or no symptoms.
–Each child conceived from two CF carriers has a 25% chance of being affected with CF, a 50% of being a carrier
Loss of cftr
have a profound impact on water and electrolyte transport across the epithelium.
CFTR is a chloride channel expressed in the
Apical membrane of epithelial cells of lung, pancreas, sweat duct, reproductive, kidney, liver, sub mucosal glands
Newborn screening tests for CF
IRT imunoreactive trypsinogen
Sweat chloride test- 75 mg of sweat collected over 30 mins
A sweat chloride test of more than what Suggests CF
60 mmol/L on two occasions
