Pulm: Asthma Flashcards
Asthma is characterized by what three pathophysiologic processes?
- chronic inflammation
- reversible obstruction
- hyperresponsiveness
80% of asthma sxs develop before what age?
5yo
What are two major sxs for asthma?
Wheezing
Nocturnal, seasonal, cough longer than 3 weeks
What medications can trigger asthma sxs?
Beta Blockers, ASA, NSAIDs
If an asthma Dx is known, what questions must be included on patient hx? (5)
- Medications
- last use of inhaler
- frequency of inhaler use
- ED visits
- hospitalization?
A patient presents with…
Increased AP diameter
Wheezing
Rhinitis sxs
Atopic dermatitis
What should you consider?
Asthma
What are 5 signs of severe obstruction in asthma?
tachypnea
tachycardia
Tripod
accessory muscle use
Pulsus paradoxus
The following is called ______ triad and is associated with _______:
Sinus dz/nasal polyps
ASA sensitivity
Severe Asthma
Samter’s Triad
Aspirine Exacerbated Respiratory Disease
The following is the _______ triad…
Atopic dermatitis
Allergic Rhinitis
Asthma
Atopic Triad
atopic dermatitis –> food allergy –> allergic rhinitis –> Asthma
This is known as…
Atopic march
The following are asthma DDx in what populations?
GERD Allergic rhinosinusitis URI CF Pertussis FB or mass RAD CHD Laryngotracheomalacia Eosinophilic bronchitis
Infants and Children
DDx in what populations?
GERD COPD CHF PE Vocal cord dysfuntion Obstructive sleep apnea chronic upper airway synd. ACE-I cough
Adolescent and adults
For what age is spirometry indicated?
> 5 yo
A patient undergoes spirometry and has the following results:
- FEV-1: < 80%
- FEV-1/FVC: normal/decreased (70-85%)
- Reversibility: > 12% or 8% in young children
Asthma
What step of asthma?
Sx 2 or fewer days/week
FEV-1 > 80%
Infrequent nighttime awakenings
2 or fewer days/week of SABA use
Step 1: Intermittent Asthma
What step of asthma?
Sxs 2+ days/week
3-5 nighttime awakenings
FEV-1 > 80%
Minor limitation of activity
2+ days of SABA use per week
Step 2: Mild persistent
What step of asthma?
Daily sxs
Weekly nighttime awakenings
FEV-1 60-80%
FEV-1/FVC reduced 5%
daily SABA use
Step 3: Moderate Persistent Asthma
What step of asthma?
Sxs throughout the day
Nightly awakenings
FEV-1 < 60%
FEV-1/FVC reduced by 5%
Extremely limited physical activity
SABA several times per day
Step 4: Severe persistent asthma
What drug is an LTRA?
Montelukast
For what ages is a LTRA used?
0-4 yo
What two drugs are monoclonal antibodies?
omalizumab
Benralizumab
Which drug is a methylxanthine?
theophyline
Who should get a SABA?
everyone
Which asthma step is managed with the following?
SABA prn
Consider low dose ICS (GINA)
Step 1
Which asthma step is managed with the following?
low dose ICS or LTRA/Cromolyn
Step 2
Which asthma step is managed with the following?
consider specialist
medium dose ICS
OR
low dose ICS + LABA/LTRA
Step 3
What is the GINA preferred tx for step 3 asthma?
medium dose ICS + ICS/LABA
Which asthma step is managed with the following?
Refer to specialist
Medium dose ICS + LABA/LTRA (0-4 yo)
Step 4
What is the GINA preferred tx for step 4 asthma?
medium/high dose ICS + LABA
Which asthma step is managed with the following?
High dose ICS + LABA
+/- Omalizumab (12+ with allergies)
Sub LABA for LTRA (ages 0-4)
Step 5
In step 5 asthma, GINA recommends what SubQ med for pts 12+ with severe eosinophilic asthma?
benralizumab
Which asthma step is managed with the following?
High dose ICS + LABA + PO Steroids
+/- Omalizumab (12+ with allergies)
Sub LABA for LTRA (ages 0-4)
Step 6
The Baylor Healthcare “Rules of Two” are…
Yes to these questions indicate…
sxs 2 x week
awaken at night 2 x month
refil inhaler 2 x yearly
peak flow < 2 x 10 (20%) from baseline?
yes = uncontrolled
Is the following asthma profile well controlled, not well controlled, or very poorly controlled?
Sx 2 or fewer / week
Nighttime awakenings:
- 0-11: 1 or less monthly
- 12+: less than 2x month
FEV-1: > 80%
FEV-1/FVC: > 80%
Well controlled
Is the following asthma profile well controlled, not well controlled, or very poorly controlled?
Sx 2+ days/week
Nighttime awakenings:
- 0-4: 1+ monthly
- 5-11: 2+ monthly
- 12+: 1-3 x weekly
FEV-1: 60-80%
FEV-1/FVC: 75-80%
Not well controlled
Is the following asthma profile well controlled, not well controlled, or very poorly controlled?
Sx daily
Nighttime awakenings:
- 0-4: 1 x weekly
- 5-11: 2+ weekly
- 12+: 4+ x weekly
FEV-1: < 60%
FEV-1/FVC: < 75%
Very poorly controlled
Peak flow > 80% indicates…
Green zone, good control
Peak flow 50-80% indicates
yellow zone, caution
A yellow zone (50-80% peak flow) should be handled by…
SABA and consider changes to meds
Peak flow < 50% indicates
Red zone, emergency
What two diagnostics outside of PFTs can be helpful in diagnosing asthma?
ABG showing respiratory alkalosis
CXR showing hyperinflation or to r/o infx/obstruction
How is an asthma exacerbation treated?
- Oxygen
- SABA/SVN (albuterol or xoponex +/- ipratropium)
- systemic CS
f/u 1 week
