Module 3- Adult asthma Flashcards
Asthma Pathognomonic
common findings are airway inflammatory cell infiltration with eosinophils, neutrophils, lymphocytes- TCELLs, goblet cell hyperplasia, plugging of small airway with mucus, collagen deposition beneath the basement membrane, bronchial smooth muscle hypertrophy, airway edema, mast cell activation, denudation of epithelium
Asthma Pathophysiology
Heterogeneous but divided into T2 high and T2 low
Allergic Asthma
childhood, and associated with eczema, allergic rhinitis, or food allergy
inhaled allergens may cause symptoms immediately or 4-6 hours after allergen exposure
T2- high endotype
reducing exposure reduces findings and symptoms
Common allergens
house dust mites, cockroaches, car dander and seasonal pollens
T2 High endotype
allergic asthma, Late-onset, aspirin/NSAID associated respiratory disease
T2 Low endotype
Non allergic asthma- Marked by neutrophils and inflammation and variable response to standard therapies
Asthma with persistent airflow limitation
due to airway remodeling
asthma with obesity
prominent respiratory symptoms on obese patients with little airway inflammation
nonspecific precipitants of asthma
upper respiratory tract infection, rhinosinututus, postnasal drips, aspiration, gastroesophageal reflux, changes in the weather, stress and exercise
Exercise- induced bronchoconstriction
begins during exercise or 3 min within 3 minutes after it ends, peaks within 10-15 minutes then resolves by 60 minutes
cough variant asthma
main symptom is cough rather than wheezing
Signs and symptoms of asthma
episodic wheezing, shortness of breath, chest tightness, and cough
often worst at nigh or morning,
prolong expiratory phase during normal breathing
chest examination btw exacerbation is normal during severe exacerbation airflow may be too limited to produce wheezing
Lab findings with asthma
ABG- normal with mild but severe hypoxemia develops but returns to normal
Pulmonary function testing
Spirometry, bronchoprovocation testing, Peak expiratory flow
spirometry
forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC
Before and after the administration of short acting bronchodilator test if reversible- increase of 12% or more and 200 ml FEV1 or FVC suggest asthma
Bronchoprovocation Testing
inhaled histamine or methacholine can help when spirometry test is negative, not recommended if FEV1 is less than 65%, Positive test is when FEV1 is 20% or more
Peak expiratory flow (PEF)
Handheld meters are devices designed as personal monitoring tools, quantify asthma severity and control
PEF values vary with age, height, and sex and are poorly standardized
Assessing control and severity of asthma
past 4 weeks
frequency of symptoms- days per week
awakening from sleep
frequency of SABA reliever use
severity is based of off level of control
Severe & uncontrolled asthma
assess inhaler technique, medication adherence, comorbities, after addressing theses if patient remains on step 4-5, referral to pulmonary or asthma
Inhaled corticosteroids
ICS
essential controller medication
as needed or Daily
Low-Medium- high doses
after symptom control for 3 months lower dose
mouth washing after to decrease systemic absorption and local side effects
SE of ICS
Local- cough, dysphonia, oropharyngeal candidiasis
systemic effects- adrenal suppression, osteoporosis, skin thinning, easily bruising, cataracts
Beta-adrenergic agonists
Short acting and Long
No one better than the other
SABA
relaxing smooth muscles with rapid onset, repetitive administration produces incremental bronchodilation- 1-2 usually sufficient for mild to moderate
Severe 6-12 puff Q30-60mins
LABA
Bronchodilation for up to 12 hours
salmetrerol formoterol
not to be used as mono-therapy
often used in combination with ICS
