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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
Q

Systemic Corticosteroids

A

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
Q

Systemic corticosteroids are…

A

primarily used for treatment of asthma exacerbations and not as maintenance therapy in asthma

27
Q

SAMA have benefit in the….

A

ED when used in conjunction with SABA during exacerbation

28
Q

ICS/Formoterol combo can be used as…

A

maintenance and reliever inhaler in patients on ICS/Formoterol (only**)

29
Q

Which Long-acting Bronchodilator is added first? Asthma

A

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
Q

LAMA usage

A

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
Q

Methylxanthine usage

A

Theophylline - usually used COPD

not recommended for ASTHMA, but alternate add-on therapy w/ ICS for NHLBI guidelines

32
Q

ICS info

A
  1. most effective long term therapy for asthma
33
Q

Budesonide preferred treatment in…

A

asthma in pregnant women

34
Q

Beclomethasone is preferred treatment in….

A

pts with CYP3A4 inhibitor drugs… HIV therapy

35
Q

Cromolyn Sodium info

A

Mast cell stabilizers

not recommended for routine use, weak efficacy

36
Q

Leukotriene Modifiers info

A

less effective than ICS therapy

option for pts w/ co-morbid allergic rhinitis, ASA sensitive or EIB

Blackbox for neuropsychiatric risks

37
Q

Macrolides info

A

Azithromycin

potential add on therapy in severe, difficult to control asthma despite moderate-high dose ICS/LABA

have to do risk/benefits

38
Q

ICS/LABA info

A
  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
Q

BADGER trial

A

comparing ICS vs ICS/LABA vs ICS/LTRA

showed that patients did best on ICS/LABA

40
Q

Benefits of biologic therapy in asthma

A

reduce exacerbations

improve symptoms/quality of life

decrease corticosteroids requirements

41
Q

Biologics will be used as…

A

add on therapy

when on high ICS/LABA and uncontrolled and have TH2 based inflammation

42
Q

Step 1: 1-5 yrs old

A

Intermittent/episodic wheezing

SABA q4-6h PRN until symptoms resolve

43
Q

Step 2: 1-5yrs old

A

Preferred controller choice: Daily dose ICS
Other options: LTRA or short courses of ICS at onset

Reliever: SABA

44
Q

Step 3: 1-5yrs old

A

Preferred controller therapy: Double “low dose” ICS
Other options: Low dose ICS + LTRA

Reliever: SABA

45
Q

Step 4: 1-5yrs old

A

Preferred:Continue controller and refer for specialist assessment

Other option: Add LTRA, increase ICS freq, or add intermittent ICS

46
Q

Step 4: 6-11 yrs old

A

Medium dose ICS-LABA or low dose MART

refer for expert advice

47
Q

Step 3: 6-11 yrs old

A

Low dose ICS-LABA or medium dose ICS or very low dose MART

48
Q

Step 2: 6-11 yrs old

A

Daily low dose ICS

49
Q

Step 1: 6-11yrs old

A

Take ICS whenever SABA taken

50
Q

Step4: >12yrs old

A

Track 1 (preferred): Medium dose ICS-formoterol maintenance and reliever (MART)

Track 2: Medium/high dose ICS-LABA + as needed SABA

51
Q

When to use track 1 vs track 2

A

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
Q

Step 3: >12 yrs old

A

Track 1: Low dose ICS-formoterol maintenance and reliever (MART)

Track 2: Low dose ICS-LABA + prn SABA

53
Q

Step 2: >12 yrs old

A

Track 1: As needed low dose ICS-formoterol

Track 2: Low dose ICS + prn SABA

54
Q

Step 1: >12 yrs old

A

Track 1: As needed low dose ICS-formoterol

Track 2: Take low dose ICS whenever SABA is taken

55
Q

Step 5: >12 yrs old

A

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
Q

What is MART therapy?

A

ICS-formoterol maintenance and reliever

CDM 1 Exam 3 (10 decks)

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