obst. lung disease - asthma Flashcards
def. asthma
inflamm. disorder of the airway causing paroxysmal or persistant Sx such as dyspnea, chest tightness, cheeze, associated with variable airflow limitations
Sx of asthma
vary in time and severity - breathlessnes - chest tightness - cough - wheeze worse at night colds "go to chest"
2 predisposing factors
- atopy
2. genetics
3 causal factors
- allergens - indoor and outdoor
2. occupational
6 contributing facotrs
- air pollution
- diet
- BMI
- low birth weight
- resp infections
- smoking
steps to Dx
- Hx and Phx
- PFT
- evaluate airway responsiveness
- exercise and methacholine challenge
what is seen on a PFT
low FEV1/FVC ratio
what is seen on PFT for diagnosis
- increases FEV1> 12% after inhaling B-agonists
- decreased PEF>10% after 6 minutes of execise
what is QOL in asthma
- 55% not well controlled
- goal should be for patient to lead a normal life
4 things to do when poorly controlled
- confirm diagnosis
- checkcompliance
- review tech.
- question exposures/env
5 parts to treatment strategy
- ID and avoid triggers
- acheive control with approp. meds
- monitor and adjust meds
- devise an action plan for exacerbations
- educate patients
what are B-agonists
- B2 selective so not heart issues
- small doses
- to site of action
what are B-agonists for
short acting
- releivers
3 B-agonist formats
- inhalers
- nebulized
- oral
what is action of inhaled corticosteroids
- reduce inflammation in the broncioles
2. preventer of further damage
2 general safety issues in steroids
- local
- candidiasis, dysphonia (cords) - systemic
- adrenal
- bruising
- cushing
what is effect on height
not one
when to start on ICS
ASAP - changes the natural Hx of the disease
2 long acting B-agonists
- salmeterol
2. formoterol
what is use of LABAs
not a monotherapy
- can help patients not be woken at night with their Sx
what are pos. effects of LABAs
- reduce SABA needs
- less night Sx
- improve QOL
- incr. FEV1
- less exacerbations
5 parts of education
- review parameters of control
- understand roles for diff. meds
- written actions
- empower patients to change meds
- demonstrated benefits in terms of QOL
