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Patho 1 (PATH 254) > Mod 3 Asthma > Flashcards

Mod 3 Asthma Flashcards

1
Q

what do COPD and Asthma have in common?

A

Airflow limitations (Air trapping) and dynamic breathing

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2
Q

What are usual characteristic of asthma according to global initiative for asthma [gina]?

A

Chronic airway inflammation w/symptoms of:
-wheeze
-SOB
- chest tightness
-cough
-variable expiratory flow limitations (Big diff from COPD)

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3
Q

Generally describe an asthma episode

A

Extreme bronchoconstriction on inhalation and expiration

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4
Q

Why is it essential to pair a corticosteroid w/SABD for a asthma attack?

A

Bronchodilators open up the airways but do nothing to treat the underlying inflammation.

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5
Q

Assessing risk for severe exacerbation

A

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

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6
Q

What is the most effective controller for asthma?

What is the time frame of affect?

A

ICS

Improvement occurs within 1-2 weeks of starting daily use.

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7
Q

suppression of Asthma; what are the most affective controllers of asthma?

edit

Slide 17

A

ICS

Suppression of:
-inflammatory genes i.e cytokines and eosinophils

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8
Q

Are ICS affective for smokers

A

Nope.

Smoke generates oxidative stress that impairs activity of ICS.

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9
Q

Describe the ICS and B2 adrenergic receptors relationship

A

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)

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10
Q

systemic corticosteroids vs. inhaled corticosteroids?
edit
need to check for accuracy

A

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

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11
Q

GINA vs CTS

A

CTS; SABA only

GINA; subbing in budesonide/formatarol as a relievers (LABA w/a shorter onset (oxeze)

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12
Q

2021 asthma management pathway

A
  1. Confirm diagnosis
  2. environmental control, education, action plan
  3. SABA or budesonide/formeterol
  4. ICS -> followed by LTRA
  5. LABA
  6. LTRA or LABA
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13
Q

budesonide can be used for what?

A

A reliever and controller

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14
Q

Reliever meds for asthma

A

salbutamol, terbutaline, and budesonide/formoterol

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15
Q

What does regular use of a reliever looked like?

and why is it important

A

More than 2 doses per week.

identifies evaluation of use of and effectiveness

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16
Q

Risk factors of improper SABA use?

A

SABAs can increase risk of exaserbation
-not controlling the inflammation enough
-should be using a ICS more effecitly in conjunction w/saba

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17
Q

What do you do when a patient can’t tolerate ICS?

A

Switch to a LTRA

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18
Q

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

A

understand CTS step approach to treatment

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19
Q

How often should asthma be reviewed for the following scenarios:

  1. After diagnosis
  2. During Pregancy
  3. After an exacerbation
A

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

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20
Q

3 strategies to manage asthma

A

Education

Environmental control; i.e allergies

pharmacotherapy

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21
Q

What is used to treat an anaphylactic reactions? (allergy based)

A

Epinephrine

w/asthma can produce a severe anaphylactic reaction

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22
Q

Asthma risk factors: How would a prenatal population get asthma?

A

Heredity

Maternal factors:

-smoking during pregnancy

-Low vit. D during pregnancy

-Cesarean delivery

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23
Q

Asthma risk factors: How would children get asthma?

A

-Eczema

-Allergic rhinitis

  • Exposure to second hand smoke

-Air pollution

-Obesity

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24
Q

Asthma risk factors: for infancy, preschool, school, age etc.?

A

exposure to allergens (antigen)
i.e fungi, dust, etc.

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25
Q

Asthma risk factors: risk factors for adulthood

A

Exposure to allergens

pollution/ Tobacco smoke/occupational exposure

drugs/additives

diet/obesity

Gender

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26
Q

What are some symptoms usually associated w/asthma?

A

Wheeze

SOB

Chest tightness

Cough

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27
Q

Asthma is primarily characterized by

A

variable expiratory airflow limitation

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28
Q

Symptoms of airflow limitation vary overtime and intensity; what factors can trigger incidents?

A

Exercise

Allergen/irritant exposure

Changes to weather

Viral resp. infections

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29
Q

How long can asthma symptoms be absent for?

A

Weeks or months at a time.

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30
Q

List some Asthma phenotypes

A

-Allergic asthma

-non-allergic asthma

-adult-onset (late-onset) asthma

-Occupational asthma

-Asthma w/obesity

-Asthma w/persistent airflow limitation

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31
Q

Define common traits of Allergic asthma:

  1. History
  2. Sputum profile
  3. Best Treatment Plan
A

Associated w/past or fam. allergic disease
-i.e eczema

Sputum profile: Treatment reveals eosinophilic airway inflammation

Usually responds well to ICS

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32
Q

Sputum profile/Traits of non-allergic asthma?

  • response to treatments?
A

Sputum profile: may be neutrophilic, eosinophilia, or contain a few inflammatory cells

Demonstrates less short term response to ICS

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33
Q

Traits of adult-onset (late-onset) asthma

A

Effects women > Men
-tend to be non-allergic

Require higher doses of ICS, relatively refractory to ICS treatment.

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34
Q

Define occupational asthma

A

repeat exposure to a sensitized in the workplace or asthma worsens in the workplace

i.e dusts, plants, animal substances

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35
Q

How is occupational asthma checked?

A

Patient history;
—ask if symptoms improve away from work

Peak expiratory flows

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36
Q

Define asthma w/persistent airflow limitation

A

Due to airway remodeling
-develop airflow limitation that is persistent or incompletely irreversible

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37
Q

Traits of Asthma w/obesity

A

Prominent respiratory symptoms and little eosinophilia airway inflammation

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38
Q

Anatomic alterations of the lungs;

what traits would be present/affected by Asthma inflamed bronchial tubes

A

Increased eosinophils

excessive secretions

hyperinflation

bronchospasm

Bronchial inflammation

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39
Q

Anatomic alterations of the lungs; Bronchial inflammation

A

Inflammation throughout the submucosa of airways; but not the alveoli/lung parenchyma.

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40
Q

Describe Primary and stimulated eosinophils during bronchial inflammation

edit

A

Slide 23

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41
Q

CTS Typical Severity Classification: Very mild

AKA well controlled

A

PRN SABA

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42
Q

CTS Typical Severity Classification: mild

A

Low dose ICS (or LTRA -> Montelukast)
+
PRN SABA or PRN bud/form [Symbicort]

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43
Q

CTS Typical Severity Classification: Moderate + well controlled

A

Low dose ICS
+
Second controller (LABA) and PRN SABA

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44
Q

CTS Typical Severity Classification: Moderate w/increasing severity

A

Moderate dose ICS +/- second controller

AND

PRN SABA or PRN low-mod. dose of Symbicort

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45
Q

CTS Typical Severity Classification: HIGH

A

High dose ICS + second controller

For previous year or systemic steroids for 50% of the previous year to prevent asthma from being uncontrolled to prevent asthma from being uncontrolled, or is uncontrollable despite this therapy.

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46
Q

True or False:

Asthma is characterized by inflammatory changes throughout the submucosa of the airways, alveoli, and lung parenchyma?

A

False

(not the alveoli or lung parenchyma)

47
Q

What is responsible for bronchial inflammation?

A

Primary eosinophils

Inflammatory molecules are recruited by cytokines

inflammation causes a positive feedback loop for more inflammation

bronchial tissue degranulate and the pro inflammatory contents induce

48
Q

Airway inflammation for asthma can lead to structural changes in the airway called airway remodeling:

list 3 changes/anatomic alterations of the lung airway remodeling causes

A

hypertrophy/hyperplasia of smooth muscles

increased goblet cells

neovascularziation/angiogenesis

49
Q

What does hypertrophy/hyperplasia of smooth muscles mean?

A

Narrowed airways

50
Q

What does it mean when goblet cells increase?

A

more secretions

51
Q

hat does angiogenesis mean?

A

new vessels remove excess inflammatory mediators away from airways

can backfire and increased perfusion can bring new inflammation

52
Q

What are 5 anatomic alterations of the lungs asthma cause?

A

Bronchospasm

Bronchial inflammation

increased eosinophils

hyperinflation

Excessive secretions

53
Q

smoke, Dust mites, animal allergies, mild, pollen and viral infections are examples of

A

Inflammatory triggers

54
Q

Non-inflammatory triggers cause

A

smooth muscle constriction

and NOT inflammation in the airways

55
Q

What are 2 non-inflammatory triggers?

A

Emotions

Temperature

Exercise

56
Q

What is GERD, what does it mean in relation to airways?

A

non-allergic intrinsic subgroup of asthma

Happens when there is a issue with the gastric sphincter causing inhalation of acidic contents causing irritation and bronchoconstriction

57
Q

Symptoms of Asthma are

A

mono/poly wheezes, SOB, Cough, and/or chest tightness

58
Q

How does asthma increase venous return?

A

Increased resistance

diaphragm drops

less pressure centrally

59
Q

What are 4 prenatal asthma risk factors?

A

Hereditary

maternal smoking during pregnancy

low vitamin D during pregnancy

C section

60
Q

What are 4 childhood asthma risk factors?

A

Eczema

Allergic Rhintis

Second hand smoke

Air pollution

Obesity

61
Q

What are 4 adult asthma risk factors?

A

allergens

tobacco

occupational exposure

drugs

pollution

obesity

62
Q

In asthma pt, induced sputum before treatment is indicative of

A

eosinophilic airway inflammation

63
Q

In terms of vitals, would you expect from someone with asthma (when symptomatic)?

A

They would most likely have increased RR and HR

64
Q

Asthma is usually associated to what?

A

airway hyper responsiveness to direct/indirect stimuli.

65
Q

In pulsus paradoxus, what happens to BP during inspiration and during expiration?

A

Inspiration: BP decreases

Expiration: BP decreases

66
Q

How do you confirm that someone has asthma w/spirometers?

A

FEV1/FVC = < 0.75-0.8

After applying bronchodilator;
-Incrase of >12% and >200mL

67
Q

How do you confirm a asthma diagnosis with a peak expiratory flow [PEF]?

A

> 20% increase after bronchodilator

68
Q

If pt answers 1-2 symptoms these, their asthma is considered

Daytime asthma symptoms more than twice a week?

Any night waking due to asthma

Reliever needed for symptoms * more than twice a week?

any activity limitation due to asthma

A

Partially controlled (uncontrolled)

69
Q

If pt answers 3-4 symptoms these, their asthma is considered?

Daytime asthma symptoms more than twice a week?

Any night waking due to asthma

Reliever needed for symptoms * more than twice a week?

any activity limitation due to asthma

A

Uncontrolled

70
Q

If pt answers 3-4 symptoms these, their asthma is considered?

Daytime asthma symptoms more than twice a week?

Any night waking due to asthma

Reliever needed for symptoms * more than twice a week?

any activity limitation due to asthma

A

well contract

71
Q

Reliever therapy:

Should bud/form be used as a reliever when controller medications other than bud/form are used

A

Nay

Symbicort is a combo drug

72
Q

Which pharm. treatments would be the most appropriate for acute symptoms?

A

Salbutamol, terbutaline, budesonide/formoterol [Symbicort]

73
Q

Well controlled asthma on PRN SABA or no med w/higher risk of exacerbation should be on which pharmacological treatment?

A

ICS + SABA PRN

74
Q

How often should patients on PRN SABA w/uncontrolled asthma take ICS + PRN?

A

Dailey

75
Q

Which age group is not recommended symbicort?

A

12 and below.

bc of poor adherence + education

76
Q

Indicators to step up asthma treatments: if poorly controlled?

A

at least 2-3 months

be sure to check for common causes

77
Q

Indicators to step up asthma treatments: short term

A

1-2 weeks, may be initiated by pt

78
Q

Indicators to step up asthma treatments: day to day

A

adjust as needed by pt for the prescribed low-dose ICS/formoterol maintainer and reliever regimen

79
Q

Indicators to step down asthma treatments?

A

Good control maintained for 3 months

80
Q

3 strategies to manage asthma

A

Education

environmental control: reduce need for asthma med

pharmacotherapy meds: treat/prevent worsening symptoms

81
Q

What is used to treat anaphylactic reactions?

A

Epinephrine

82
Q

Where are Beta 1 receptors are found

A

Heart and kidneys

83
Q

Beta 1 cause increase in?

A

Inotrophy (rhythm)

HR

Renin in kidneys

84
Q

What does renin in the kidneys do?

A

Balance NA+ AND K+ LEVELS

Balance BP

85
Q

Beta 3 receptors are located in?

A

Adipose tissue

They activate lipolysis (breakdown of fats and lipids)

86
Q

Adrenergic receptors are typically associated w/which receptors ?

A

Alpha and Beta

87
Q

Difference between Alpha 1 and 2 receptors?

A

A1 = contraction

A2 = inhibit

88
Q

Beta 1 receptors generally affect the which organs?

A

Heart and kidney

89
Q

Beta 2 receptors affect the?

A

pulmonary system
(bronchial smooth muscle)

90
Q

PNS only uses which 2 neurotransmitters?

A

Acetylcholine and Norepinephrine

91
Q

Somatic motor neurons release what NT?

A

Acetylcholine

92
Q

How do LAMA’s work?

A

LAMAs affect muscarinic agents located on smooth muscles; muscarinic agents active AcH which constricts airways.

preventing AcH activation via inhibition of muscarinic agents relaxes airways

93
Q

what would the neurotransmitter AcH normally do to the body?

A

Affect vessel tone; [PNS] releases AcH to stimulate muscarinic receptors in the airway smooth muscle, causing contraction and narrowing of the airway.

94
Q

What is the function of anticholinergic drugs?

A

Prevent AcH binding to/blocking muscarinic receptors (that respond to AcH)

-AcH is involved w/vessel tone, HR, and glandular secretions; factors that increase airway resistance.

Can improve breathing for COPD and Asthma because airway constriction is reduced

95
Q

What traits does Asthma have in terms anatomic alterations of the lungs?
(3)

A
  1. Reversible bronchial airway smooth muscle constriction
  2. Airway inflammation
  3. increased airway responsiveness to stimuli
96
Q

What happens to airways when they become inflamed and infiltrated with eosinophils and goblet cells?

A

mucous all edema bc goblet cells increase,

Become filled w/mucous which can lead to plugging and atelectasis

97
Q

Define Extrinsic asthma

A

Hypersensitivity reaction to stimuli (allergic/atopic)

98
Q

Define intrinsic asthma

A

Nonallergenic/non-atopic asthma

can’t be linked to a specific antigen/extrinsic inciting factor

not hypersensitive and develops in adult years

99
Q

What is a Biphasic response?

A

An early asthmatic response followed by a late asthmatic response

100
Q

GINA guideline for symptoms of asthma?
(4)

A
  1. cough
  2. recurrent wheeze
  3. recurrent difficult breathing
  4. recurrent chest tightness

other = worsening symptoms over night
colds that go to chest or take more than 10 days to clear

101
Q

2 main diagnostic/monitoring tests for asthma

A

Spirometers

Peak expiratory flow [PEF]

102
Q

4 levels/classes of asthma severity (4)

A

Intermittent: < 1 a week

mild: > 1 a week but < once a day

moderate: occurs dailiy

severe: daily w/nocturnal symptoms. limits physical activity

103
Q

Describe the asthma mnemonic plan [SOAP]

A

Structured method of documenting pt progress/plan of treatment

S: Subjective [Pt symptoms]

O: Objective [vitals]

A: Assessment [i.e bronchospasm, metabolic acidosis etc.]

P: Plan

104
Q

[SOAP] - discussion/example

what protocol could be followed for the following plan?

-o2 therapy protocol
-aerosolized medication therapy protocol

A

Oxygen therapy protocol [FiO2 80-100% via NRB]
-monitor w/SpO2 oximeter

Aerosolized med therapy
-med. neb q30m w/saba
-monitor PEFR and breath sounds
-review abgs

105
Q

What is Asthma typically characterized by?

A

** inflammation and narrowing of the airways in the lungs, which can cause breathing difficulties**

106
Q

What diagnostic tools are the accepted standard to establish the diagnosis of bronchiectasis?

A
  1. CT
  2. PFT
  3. Sputum culture
  4. Bronchoscopy
107
Q

All the following are a prenatal risk factor for asthma except:

a. low vitamin D during pregnancy

b. Cesarean delivery

C. Maternal smoking

D. low progesterone during pregnancy

A

D

108
Q

what type of asthma responds the best to ICS?

A

Atopic (allergic) asthma

109
Q

Asthma with persistent airflow limitation is due to what?

A

Airway remodeling and chronic inflammation of airways

110
Q

Asthma with variable airflow limitation is due to what?

A
  • Environmental factors
  • Asthma w/obesity
  • irritants
  • exercise
111
Q

Gold standard for diagnosing asthma?

A

Spirometry test

112
Q

Asthma criteria if patient has 0 symptoms to questions?

A

Well controlled

113
Q

After making changes to a therapy, when should you reassess the effectiveness?

A

After 1-3 months

Patho 1 (PATH 254) (17 decks)

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