Mod 3 Asthma Flashcards
what do COPD and Asthma have in common?
Airflow limitations (Air trapping) and dynamic breathing
What are usual characteristic of asthma according to global initiative for asthma [gina]?
Chronic airway inflammation w/symptoms of:
-wheeze
-SOB
- chest tightness
-cough
-variable expiratory flow limitations (Big diff from COPD)
Generally describe an asthma episode
Extreme bronchoconstriction on inhalation and expiration
Why is it essential to pair a corticosteroid w/SABD for a asthma attack?
Bronchodilators open up the airways but do nothing to treat the underlying inflammation.
Assessing risk for severe exacerbation
History of severe asthma exacerbations; ED visit
Poorly asthma controlled asthma per CTS critera
Overuse of SABAs i.e > 2 a year (or no ICS use)
current smoker
What is the most effective controller for asthma?
What is the time frame of affect?
ICS
Improvement occurs within 1-2 weeks of starting daily use.
suppression of Asthma; what are the most affective controllers of asthma?
edit
Slide 17
ICS
Suppression of:
-inflammatory genes i.e cytokines and eosinophils
Are ICS affective for smokers
Nope.
Smoke generates oxidative stress that impairs activity of ICS.
Describe the ICS and B2 adrenergic receptors relationship
ICS can activate B2 receptors; enhancing B2 agonist effects
ICS can also prevent the down regulation of B2 receptors (increasing expression of them on the cell surface)
systemic corticosteroids vs. inhaled corticosteroids?
edit
need to check for accuracy
One is broader vs. the lungs itself
Inhaled have the same affect for asthma as systemic but w/o the issues that come with systemic use
GINA vs CTS
CTS; SABA only
GINA; subbing in budesonide/formatarol as a relievers (LABA w/a shorter onset (oxeze)
2021 asthma management pathway
- Confirm diagnosis
- environmental control, education, action plan
- SABA or budesonide/formeterol
- ICS -> followed by LTRA
- LABA
- LTRA or LABA
budesonide can be used for what?
A reliever and controller
Reliever meds for asthma
salbutamol, terbutaline, and budesonide/formoterol
What does regular use of a reliever looked like?
and why is it important
More than 2 doses per week.
identifies evaluation of use of and effectiveness
Risk factors of improper SABA use?
SABAs can increase risk of exaserbation
-not controlling the inflammation enough
-should be using a ICS more effecitly in conjunction w/saba
What do you do when a patient can’t tolerate ICS?
Switch to a LTRA
slide 27 won’t be tested. but the second line on gina is the general rule of thumb that we follow
don’t worry about slide 30
understand CTS step approach to treatment
How often should asthma be reviewed for the following scenarios:
- After diagnosis
- During Pregancy
- After an exacerbation
1. [1-3] months after treatment started, then every [3-12] months
2. During pregnancy: Every [4-6] weeks
3. After an exacerbation: within 1 week
3 strategies to manage asthma
Education
Environmental control; i.e allergies
pharmacotherapy
What is used to treat an anaphylactic reactions? (allergy based)
Epinephrine
w/asthma can produce a severe anaphylactic reaction
Asthma risk factors: How would a prenatal population get asthma?
Heredity
Maternal factors:
-smoking during pregnancy
-Low vit. D during pregnancy
-Cesarean delivery
Asthma risk factors: How would children get asthma?
-Eczema
-Allergic rhinitis
- Exposure to second hand smoke
-Air pollution
-Obesity
Asthma risk factors: for infancy, preschool, school, age etc.?
exposure to allergens (antigen)
i.e fungi, dust, etc.