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CDM 1 Exam 3 > Respiratory: Asthma 1 > Flashcards

Respiratory: Asthma 1 Flashcards

1
Q

FENO

A

Fractional Exhaled Nitric Oxide

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2
Q

SCIT

A

Subcutaneous Immunotherapy

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3
Q

SLIT

A

Sublingual Immunotherapy

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4
Q

FEV1

A

Forced Expiratory Volume in 1 second

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5
Q

FVC

A

Forced Vital Capacity

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6
Q

PEF

A

Peak Expiratory Flow

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7
Q

wheezing

A

High pitched noise usually heard upon exhalation

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8
Q

“Personal best” is used to

A

monitor patients with asthma to monitor day to day asthma and if its under control

Take peak flow when asthma is under control, and then day to day peak flow is compared to that

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9
Q

EIB can be pre-treated with…

A

certain bronchodilators

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10
Q

Asthma definiton

A

characterized by chronic airway inflammation

defined by history of respiratory symptoms such as wheeze, SOB, chest tightness and cough that VARY OVER TIME AND INTENSITY, together with variable expiratory airflow limitation

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11
Q

Asthma Phenotypes

A 
Allergic
Non-alergic
Adult-onset
Asthma w/ persistent airflow limitation
Asthma w/ obesity
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12
Q

Host risk factors for Asthma

A

Innate immunity (Hygiene Hypothesis)
Genetic factors
Age
Sex

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13
Q

Environmental risk factors Asthma

A 
Allergens
Pollution
Infections
Microbes
Stress
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14
Q

Other Asthma Risk factors

A

Ethnicity- AA 2X as likely
Urbanization - living in city
Socioeconomic status - more common in low income

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15
Q

COPD vs Asthma

A

COPD - neutrophilic inflammation

Asthma - eosinophilic inflammation

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16
Q

Basic concept of Th1/2 cells in Asthma

A

Born with more Th2, and exposure to germs will cause an increase in Th1 cells

increasing Th2 = increase Asthma/Allergies

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17
Q

Pathophysiology of Asthma

A

Allergen presented to T cell, causing B cell to be activated.

Activated B cell will make IgE antibody for it, these will go onto mast cells and basophils.

Next time exposed to allergen, IgE antibodies will link on mast cell and cause mediatory release and a Bi-phasic inflammatory response

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18
Q

Eosinophilic Inflammation

A

Mast cells and Th2 cells release GM-CSF and IL-5.

This leads to differentiation of Eosinophil. These come to lungs and release inflammatory mediators that can cause airway injury

Repeat process of injury = issues

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19
Q

What happens in Asthma?

A

Bronchoconstriction - within min
Airway edema - over hours/days

Airway hyperresponsiveness - exaggerated bronchoconstrictor response that is present even when asymptomatic due to chronic inflammation

Airway remodeling - long term due to inflammation

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20
Q

Feno >50 or >35 (kids 5-12) is indicative of…

A

asthma and T2 inflammation

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21
Q

SABA info

A

Therapy of choice prior to exercise to prevent EIB

Albuterol preferred in pregnancy

Preferred rescue inhaler pts not on ICS/Formoterol

GINA doesn’t recommend SABA only therapy = inc mortality

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22
Q

SAMA info

A

longest onset of action to SABA

Alternative for pt who don’t tolerate SABA

Additive benefit to SABA in exacerbations in the ED setting

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23
Q

Preferred therapy for Asthma

A

ICS/ Formoterol

Budesonide/Formoterol (Symbicort)

24
Q

Max ICS/Formoterol doses

A 
8 puffs (36 mcg children)
12 puffs (54 mcg adults)
25
Systemic Corticosteroids
Prednisone increased side effects compared to ICS for moderate/severe asthma exacerbations long term prevention of symptoms in severe, persistent, difficult to control asthma
26
Systemic corticosteroids are...
primarily used for treatment of asthma exacerbations and not as maintenance therapy in asthma
27
SAMA have benefit in the....
ED when used in conjunction with SABA during exacerbation
28
ICS/Formoterol combo can be used as...
maintenance and reliever inhaler in patients on ICS/Formoterol (only**)
29
Which Long-acting Bronchodilator is added first? Asthma
LABA - Salmeterol 1st line add-on therapy to ICS/Formoterol therapy adding LABA = can decrease ICS dose ** cant use in ppl < 4 yrs old **
30
LAMA usage
Tiotropium improvements in exacerbation rate when used in addition to ICS/LABA preferred add on to ICS/LABA in Step 5 for >12 yrs old
31
Methylxanthine usage
Theophylline - usually used COPD not recommended for ASTHMA, but alternate add-on therapy w/ ICS for NHLBI guidelines
32
ICS info
1. most effective long term therapy for asthma
33
Budesonide preferred treatment in...
asthma in pregnant women
34
Beclomethasone is preferred treatment in....
pts with CYP3A4 inhibitor drugs... HIV therapy
35
Cromolyn Sodium info
Mast cell stabilizers not recommended for routine use, weak efficacy
36
Leukotriene Modifiers info
less effective than ICS therapy option for pts w/ co-morbid allergic rhinitis, ASA sensitive or EIB Blackbox for neuropsychiatric risks
37
Macrolides info
Azithromycin potential add on therapy in severe, difficult to control asthma despite moderate-high dose ICS/LABA have to do risk/benefits
38
ICS/LABA info
1. reduces use of SABA for quick relief 2. Allows for lower doses of ICS, reducing risk of adverse effects 3. More effective than ICS/LTRA combo 4. preferred maintenance therapy for majority of steps in ages >4, + SABA PRN
39
BADGER trial
comparing ICS vs ICS/LABA vs ICS/LTRA showed that patients did best on ICS/LABA
40
Benefits of biologic therapy in asthma
reduce exacerbations improve symptoms/quality of life decrease corticosteroids requirements
41
Biologics will be used as...
add on therapy when on high ICS/LABA and uncontrolled and have TH2 based inflammation
42
Step 1: 1-5 yrs old
Intermittent/episodic wheezing SABA q4-6h PRN until symptoms resolve
43
Step 2: 1-5yrs old
Preferred controller choice: Daily dose ICS Other options: LTRA or short courses of ICS at onset Reliever: SABA
44
Step 3: 1-5yrs old
Preferred controller therapy: Double "low dose" ICS Other options: Low dose ICS + LTRA Reliever: SABA
45
Step 4: 1-5yrs old
Preferred:Continue controller and refer for specialist assessment Other option: Add LTRA, increase ICS freq, or add intermittent ICS
46
Step 4: 6-11 yrs old
Medium dose ICS-LABA or low dose MART refer for expert advice
47
Step 3: 6-11 yrs old
Low dose ICS-LABA or medium dose ICS or very low dose MART
48
Step 2: 6-11 yrs old
Daily low dose ICS
49
Step 1: 6-11yrs old
Take ICS whenever SABA taken
50
Step4: >12yrs old
Track 1 (preferred): Medium dose ICS-formoterol maintenance and reliever (MART) Track 2: Medium/high dose ICS-LABA + as needed SABA
51
When to use track 1 vs track 2
if think they will be adherent than track 2 is okay. if don't think they will be adherent better to do track 1 (preferred), less inhalers to worry about Track 1 reliever: ICS-formoterol Track 2 reliever: SABA
52
Step 3: >12 yrs old
Track 1: Low dose ICS-formoterol maintenance and reliever (MART) Track 2: Low dose ICS-LABA + prn SABA
53
Step 2: >12 yrs old
Track 1: As needed low dose ICS-formoterol Track 2: Low dose ICS + prn SABA
54
Step 1: >12 yrs old
Track 1: As needed low dose ICS-formoterol Track 2: Take low dose ICS whenever SABA is taken
55
Step 5: >12 yrs old
Track 1: Add on LAMA, refer for phenotypic assessment Consider high dose ICS-Formoterol Track 2: Add on LAMA,refer for phenotypic assessment Consider high dose ICS-LABA
56
What is MART therapy?
ICS-formoterol maintenance and reliever

CDM 1 Exam 3 (10 decks)

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