Resp 2 Flashcards
asthma
variable airflow obst - often reversible with meds
bronchial hyper-responsiveness which has various triggers (chronic airway inflammation - airway remodeling)
asthma epidemiology
most common chronic dx in kids
5,000 deaths/yr (80-90% are preventable)
most deaths occur out of hospital bc of inadequate therapy
asthma pathophys
eosinophils and mast cells
mediators
prostaglandins, thrombaxanes and leukotrienes
pharm targets for asthma
bronchodilators
anti-inflamm’s
leukotriene rec antagonists
anti-interleukin ABs
bronchodilators
B2 agonists (rescue med for acute exacerbations)
anticholinergics (less so with asthma, more COPD)
theophyline
anti-inflamm agents
inhaled GS (suppression of underlying inflammation)
frequency of asthma symptoms
intermittent (step 1) or persistent (step 2-4)
severity is mild, mod or severe
dx tests for asthma
abnormal PFTs that improve by >/= 15% after bronchodilator therapy
general approach to tx of asthma
education to pt’s/caregives
pharmacotherapy
individualization
2 main options (bronchodilators or inhaled CS)
strep 1
no long term control
SABA for quick relief PRN
step 2
long term: low-dose ICS or LTRA (montelukast)
quick relief: SABA
step 3
long term: low-dose ICS + LABA or medium dose ICS or low-dose ICS + LTRA
quick relief with SABA
step 4
long term: medium or high dose ICS + LABA
or medium/high dose ICS + LABA and/or LAMA or high dose ICS + LTRA/theophylline
quick relief with SABA
ICS’s asthma
high dose systemic steroids are used for status asthmatics or severe asthma unresponsive to Beta agonists minimal toxicity at low-mod dose BID dosing reduces oral thrush 1st line for persistent asthma doses not interchangeable
cholinergic antagonists asthma
not as potent as B2-ag’s
quaternary NH4 agents have poor abs
limits systemic abs and systemic effects
anticholinergics inhibit constrictive tone
asthma pharmacotherapy summary
agents are either quick-relief or long term
anti-inflam’s are preferred for long-term control
a step-wise tx approach is preferred
SABA is used for rescue
COPD
chronic bronchitis or emphysema
RF is cig smoking
inflam differs from that of asthma
has exacerbations
chronic bronchitis
chronic or recurrent excessive mucus sec into bronchial tree
cough occurring most days > 3 months/yr for at least 2 consecutive yrs
blue bloaters dur to CO2 retention
percussion is resonant
BS distant to auscultation
emphysema
defined by anatomic pathology permanent/enlarged air spaces destruction of alveolar walls minimal cough pink puffers due to tachypnea pursed lips compensates for loss of elastic recoil sitting forward to minimize E of breathing uses accessory mm for breathing hyper resonant on percussion
COPD exacerbation
worsening beyond normal day-to-day variation and leads to change in meds
1-2 a yr
>80% managed outpt
severe exacerbation in hospital (accessory mm use, cyanosis, peripheral edema)
life-threatening exacerbation in ICU (AMS, worsening respiratory status, hemodynamic unstable)
abx in COPD
abx for exacerbations, not prophylaxis
only effective in setting of info
used for 7-10 days
O2 in COPD
low dose long-term (cont O2 has been shown to dec mortality, improves QOL and dec’s time in hospital)
nasal canal at 2-3 L/min
raise PaO2 to > 60 mm Hg is goal
avoid flames
high dose O2 inhibits resp drive so COPD pt’s may die in sleep
stepwise drug therapy in COPD
short acting inhaled bronchodilator for acute symptoms long acting inhaled bronchodilator combo anticholinergic + B-agonist consider theophylline combo inhaled CS + long acting B-agonist
