Learning Objectives - Asthma Flashcards
Mechanism of hypoxemia in asthma?
V/Q mismatch
Acid-base disturbance in mild vs. severe asthma?
Mild - hyperventilation -> respiratory alkalosis
In-between -> normal ABG
Severe -> hypoventilation + Co2 retention -> respiratory acidosis
Rx acute severe asthma exacerbation?
- Inhaled beta-2 agonist via nebulizer or MDI (mainstay)
- Assess response with peak flows
- IV corticosteroids, taper with clinical improvement, initiate inhaled
- Third-line agent - IV magnesium (helps with bronchospasm)
- Supplemental O2
Define mild intermittent asthma.
Symptoms 2 or less times/week
Rx mild intermittent asthma
Albuterol PRN
Define mild persistent asthma.
Symptoms 2+/week but not everyday, wake up 2x/month with symptoms
Rx mild persistent asthma
Albuterol PRN
Low dose inhaled corticosteroid
Define moderate persistent asthma
Daily symptoms with frequent exacerbations, wake up >2x/month with symptoms
Rx moderate persistent asthma
Albuterol PRN
Daily inhaled corticosteroid (low dose) + long-acting beta agonist, i.e. salmeterol (OR + leukotriene modifier i.e. montelukast, OR + theophylline)
OR
Daily medium dose inhaled corticosteroid
Define severe persistent asthma
Continual symptoms
Frequent exacerbations
Limited physical activity
Rx severe persistent asthma
Albuterol PRN
Daily inhaled corticosteroid (medium or high dose) + long-acting beta-agonist
Consider omalizumab (anti-IgE)
Consider systemic steroids if poor control
Discuss the efficacy and use of leukotriene inhibitors.
Less efficacious than inhaled steroids
Useful for prophylaxis and mild asthma
May allow reduciton in steroid and bronchodilator requirements
AE of inhaled corticosteroids?
Thrush, sore throat, hoarse voice (prevent with spacer)
Osteoporosis risk if premenopausal
Glaucoma
Cataracts
True or false - yellow sputum implies infection.
False - yellow sputum implies inflammation but not necessarily infection
True or false - people with asthma are more likely to get the flu.
False - people with asthma are NOT more likely to get the flu, but influenza can be more serious for people with asthma. They can trigger asthma attacks and a worsening of symptoms. It can also lead to pneumonia.
