Lecture 56 - Dx and Tx of Asthma Flashcards
what is asthma?
What is it? Chronic inflammatory d/o of the airways
Intermittent; Recurrent episodes of: wheezing, coughing, breathlessness, and chest tightness
What cells are involved with an asthmatic reaction?
Cells involved: T lymphocytes, macrophages, mast cells, eosinophils, and epithelial cells
How does asthma differ from COPD
Asthma – airway obstruction from inflammation/smooth muscle contraction
COPD - destruction of the parenchyma; increased compliance; airway collapse
What factors are used for the dx of asthma ?
which are the most important
History
Physical
PFTs – most important
Imaging
describe some HPI findings?
Symptoms often Manifest a young age
Symptoms: SOB, cough (w/ or w/o sputum), Chest tightness
Symptoms are intermittent, seasonal, exercise induced, environmental
Symptoms may occur in response to stimuli – allergens,
PMH -- allergic disese (eczema, allergic rhinitis) FH -- allergic diseases or asthma Social -- themselves are often non smokers; ask about hobbies and occupational exposures, home environment (mold, carpets, pets)
Physical exam findings of asthma?
Physical Exam:
Wheezing – cardinal finding; high pitched sound on expiration
Hyper resonance on percussion
Vital Signs – depends on severity of symptoms; tachycardia, tachypnea
Spirometry findings of an obstructive lung disease?
Low FVC
Low FEV1
Low FEV1/FVC
how can you tell if the lung obstuction is reversible ?
Bronchodilator Response:
12% (10-15%) Change in FEV 1,
that is at least 200 cc improved
What is another pharmacological test to help confirm a diagnosis of asthma ?
Testing Bronchial Hyper-responsiveness:
- administer increasing doses of Methacholine (cholinergic agonists);
Patient is asthmatic with >20% decline in FEV1
what is a short term treatment for asthma?
Rescue Inhalers – SABA
what are some long term control medications for asthma ?
Inhaled Corticosteroids
LABA
Leukotriene Modifiers
Mast Cell Stabilizers
Immunomodulators – Omalizumab
asthma severity:
Mild Intermittent
Mild Persistent
Mild Intermittent
- rare night time symptoms
Symptoms < 2 x week;
Asymptomatic and normal PFTs been exacerbations
Mild Persistent
Night Time sx > 2 x per month
Symptoms > 2 x a week but less than 1 x per day
Asthma severity
Moderate persistent
Moderate Persistent: night time > 1x per week Daily symptoms daily use of SABA Exacerbations affect activity and occur > 2 x week
Severe Persistent:
Frequent night time symptoms
Continual symptoms which limite physical activity; frequency exacerbations
STEP UP/STEP DOWN
- what is the baseline therapy?
- what meds are used from there ?
Baseline - SABA PRN
next: + low dow ICS
next: medium ICS + LABA
next: higher dose ICS + LABA (consider immuno)
next: ICS+ LABA + oral corticosteroid
when are systemic corticosteroids usdd ?
severe exacerabations; uncontrolled asthma
what 3 things should always be considered when treating patients? if overlooked the treatment might not work anyay
Adherence
Environmental Control
Comorbid Conditions
What is the primary complication of asthma?
How can this lead to hypercapnea?
Treat?
Acute Asthma Exacerbations
Inadequate Ventilation or respiratory muscle failure
Treat: nebulized beta agonists; systemic corticosteroids; supportive care
what are some special forms of asthma?
exercise induced
ASA sensitive
Work Related
Allergic Bronchopulmonary aspergillosis
Asthma in pregnancy
