Chronic Asthma Flashcards
Asthma Definition
A heterogeneous disease, chronic airway inflammation, history of symptoms that vary over time/ intensity, and variable expiratory airflow limitation
Presentation of illness
Episodes of dyspnea
• Episodes of wheezing
• Tightness in the chest
• Chronic daily symptoms to only intermittent symptoms
• Intervals between symptoms can be weeks, months, or
years
• Characterized by recurrent exacerbations and
remissions
Initial assessment and diagnosis: Determine
History of variable respiratory systems
Confirm expiratory airflow limitation
alternative diagnosis are excluded
Initial assessment and diagnosis: Methods
Detailed medical history
physical exam
Spirometry
Questions asked during medical History
Type of symptoms • Pattern of symptoms • Precipitating or aggravating factors • Development of disease and treatment • Family history • Social history • Profile of a typical exacerbation • Impact of asthma on patient and family • Assessment of patient/family’s perceptions
Triggers that worsen asthma symptoms
Respiratory infections, environmental factors, Psychological Factors, and obesity.
Other factors include
Rhinitis/sinusitis, GERD, female hormones, preservatives and medications
Physical examination stuff that helps us find out if its asthma
Hyperexpansion of the thorax
wheezing
Atopic dermatitis/ eczema
Diagnosing asthma in Kids 5 years and younger
Challenging. more likely to occur if:
• Wheezing or coughing occurs with exercise, laughing or
crying in the absence of respiratory infection
• History of other allergic disease (eczema or allergic rhinitis)
• Asthma in first-degree relatives
• Clinical improvement during 2-3 months of controller
treatment and worsening after cessation
Patient characteristics that decrease the probability of asthma
Isolated cough with no other respiratory systems
chronic production of sputum
SOB associated with dizziness, light headedness, and peripherial tingling
chest pain
exercise induced dyspnea with noisy insparation (stridor)
Asthma domains: symtom control
Burden to pts
Increases risk of exascerbations
Asthma Domins: future risk of adverse asthma outcomes
Flare ups
loss of lung function
medication side effects
Risk factors that increase exascerbation factors
Uncontrolled asthma Inadequate ICS, not prescribed, poor adherence, incorrect technique Greater than or equal to 1 exacserbation in previous year Higher bronchodilator Reversibility Socioeconomic or psychological problems Cormorbidites Sputum or blood eosinophilia Pregnancy FENO Exposures such as smoking Low FEV less than 60 % High SABA use intubated or ICU for asthma Premature birth
