Respiratory Dysfunction (Part 3, Asthma) - Unit 2

Question 1

Asthma - most common chronic disease of childhood. T/F?

Answer 1

True

Question 2

What is asthma?

Answer 2

Chronic inflammatory disorder of airways - bronchial hyperresponsiveness to a variety of irritants due to inflammation.

Question 3

Asthma - continuous. T/F/

Answer 3

FALSE - episodic and can go away and come back at the drop of a hat.

Question 4

What are the 4 asthma categories?

Answer 4

Intermittent, mild persistent, moderate persistent, severe persistent

Question 5

When does asthma occur with intermittent asthma?

Answer 5

Symptoms less than twice weekly, no nighttime symptoms for ages 0-4, less than twice monthly for ages 5-11, peak expiratory flow greater or equal to 80% of expected value.

Question 6

Mild persistent asthma - when?

Answer 6

Symptoms occur twice weekly but not daily.
Nighttime symptoms occur 1-2 times monthly for ages 0-4 and 3-4 times monthly for ages 5-11.
Peak expiratory flow greater than or equal to 80% of predicted value.

Question 7

Moderate persistent asthma - when?

Answer 7

Symptoms occur DAILY
nighttime symptoms occur 3-4 times monthly for ages 0-4 and more than once a week but not daily for ages 5-11.
Peak expiratory flow 60-80% of expected value

Question 8

Severe persistent asthma - when?

Answer 8

Symptoms occur throughout the day, nighttime symptoms are frequent, peak expiratory flow

Question 9

Asthma - can occur hours after exposure. T/F?

Answer 9

True

Question 10

Asthma - heightened airway reactivity due to inflammation. T/F?

Answer 10

True

Question 11

What is the asthmatic response? (Think patho)

Answer 11

Antigen is deposited on respiratory mucosa —> immune response is initiated —> IgE attaches to mast cells and basophils —> histamine, leukotrienes, serotonin and other mediators are released.

Question 12

Air trapping - occurs in asthma. T/F?

Answer 12

True

Question 13

Chronic inflammation that leads to permanent damage to the structures of the airway is referred to as what?

Answer 13

Airway remodeling

Question 14

What are some risk factors for asthma?

Answer 14

Age, atopy (predisposition to allergic reactiosn), heredity, gender (boys), mother

Question 15

What are some manifestations of asthma?

Answer 15

Dyspnea, wheezing, coughing, chest tightness and/or pain, symptoms may worsen at night, irritability, restlessness

Question 16

It is easier to detect an asthma attack in an infant - T/F? Why?

Answer 16

FALSE - well it’s not labeled as asthma until 2 years old..ha, trick question!

Question 17

What are some long-term control meds for asthma?

Answer 17

Inhaled corticosteroids, cromolyn sodium and nedocromil, long-acting B2 agonists, methylxanthines, leukotriene modifiers, long-term bronchodilators (serevent)

Question 18

What are some quick-relief (rescue) meds for asthma?

Answer 18

Short acting beta2 agonists, anticholinergics, systemic corticosteroids

Question 19

If giving theyphylline (a Nonselective phosphodisterase enzyme inhibitor) for asthma, what do we monitor?

Answer 19

Serum levels

Question 20

How are most drugs for asthma given?

Answer 20

They are inhaled. MDI with a spacer is best! Sometimes a nebulizer is used as well.

Question 21

Inhaled steroids have little long term effects. T/F?

Answer 21

True

Question 22

What does cromolyn sodium do?

Answer 22

It’s a mast-cell stabilizer that interferes with mediator release and stops acute airway narrowing after exercise.

Question 23

Beta 1 blockers affect..

Beta 2 blockers affect..

Answer 23

1 = heart (1 heart!)

2 = lungs (2 lungs!)

Question 24

What are some beta-adrenergic agonists?

Answer 24

Albuterol, xopenex, terbutaine - they are for acute exacerbations and bind with beta receptors on smooth muscles allowing relaxation of smooth muscle.

Question 25

What is the name of a long-acting beta 2 agonist? What ages should get it?

Answer 25

Salmeterol - 12 and above!

Question 26

What do the leukotriene modifiers do? Drug names?

Answer 26

They stop inflammation and bronchospasm.

Zafirulkast (Accolate) and Montelukast Sodium

Question 27

What are the anticholingerics? What are they used for?

Answer 27

Atropine, Ipratropium - relief of acute bronchospasm.

Question 28

What is omalizumab (xolair)? When/where is it given?

Answer 28

Monoclonal antibody, stops IgE from binding to mast cells - Given SQ 1-2 times monthly.

Question 29

What is magnesium sulfate used for? given how?

Answer 29

Muscle relaxant that decreases inflammation - given IV

Question 30

what are some signs of SEVERE respiratory distress in children with asthma?

Answer 30

Remains sitting upright & refuses to lie down, sudden agitation, agitated child who suddenly becomes quiet, diaphoresis

Question 31

What is status asthmaticus?

Answer 31

respiratory distress continues despite vigorous therapeutic measure - maybe concurrent with an infection.

Question 32

How do we treat status asthmaticus?

Answer 32

Epi, 0.01 ml/kg subQ, Iv mag sulfate, IV ketamine, IV corticosteroids, heliox