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702 > Asthma > Flashcards

Asthma Flashcards

1
Q

What are some s/s of asthma?

A

On-and-off nature of symptoms**
- Dyspnea/chest tightness
- Wheezing
- Cough
- Tachypnea/cardia
- Hypoxemia
- Airflow obstruction on PFT
- Bronchial hyperresponsiveness

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2
Q

SABA side effects

A

Adrenergic stuff
- Tremor
- Shakiness
- Lightheadedness
- Cough
- Palpitations
- Hypokalemia
- Tachycardia
- Hyperglycemia

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3
Q

ICS side effects

A
  • Growth concerns in young children
  • Hyperglycemia, fracture risk
  • Oropharyngeal candidiasis**
  • Dysphonia**

Use lowest dose possible and decrease dose 25-50% after stable for 3 months

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4
Q

ICS pearls

A

Monotherapy for control only
- Counsel to rinse and spit after use
- Avoid DPIs in children <4
- NEVER shake DPIs, but shake MDIs
- Avoid DPIs in milk allergy
- Budesonide nebulizer preferred in children <4

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5
Q

Which ICS has less thrush/hoarseness?

A

Ciclesonide

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6
Q

Which ICS has more thrush/hoarseness?

A

Fluticasone

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7
Q

Which ICS inhalers are MDIs that do not need to be shaken?

A

Qvar RediHaler (Beclomethasone)

Ciclesonide (Alvesco)

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8
Q

Which ICS is preferred in children <4?

A

Budesonide nebulized

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9
Q

Probably asthma > COPD when…

A
  • Multiple symptoms
  • Symptoms vary over time (worse at night/early morning)
  • Identifiable triggers
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10
Q

Probably COPD > asthma when…

A
  • Chronic sputum production
  • Isolated cough
  • SOB -> dizziness, lightheadedness, tingling
  • Chest pain
  • Exercise-induced dyspnea with stridor
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11
Q

How to assess asthma control

A
  • Symptom control
  • Risk factors
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12
Q

Symptom control questions

A

Daytime asthma symptoms more than twice per week?
Any night awakening due to asthma?
Reliever (not including ICS/formoterol) used for symptoms (not prior to exercise) more than twice per week?
Any activity limitation due to asthma?

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13
Q

Symptom control scores

A

Well controlled - 0
Partially controlled - 1-2
Uncontrolled - 3-4

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14
Q

Risk factors for exacerbation

A
  • No ICS
  • Poor adherence/technique
  • High SABA use
  • Comorbidities
  • Smoking, allergens, pollution
  • Major socioeconomic problems
  • Low FEV1
  • Sputum/eos
  • Previous exacerbation (esp. if intubated)
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15
Q

Additional risk factor for fixed airflow limitation

A

Preterm/LBW

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16
Q

Risk factors for medication side effects

A
  • Frequent oral CS (especially with CYP450 inhibitors)
  • Potent or high-dose ICS
  • Long term
  • Poor inhaler technique
17
Q

Step 1-2 Symbicort

A

Low dose PRN

1 puff whenever needed

18
Q

Step 3 Symbicort

A

Low dose maintenance + PRN

1 puff once or twice* daily + 1 puff whenever needed

19
Q

Step 4 Symbicort

A

Medium dose maintenance + PRN

2 puffs twice daily + 1 puff whenever needed

20
Q

Step 5 Symbicort

A

Medium-high dose maintenance + PRN

2 puffs twice daily + 1 puff whenever needed

21
Q

How do you step down?

A

Document baseline status
- Write asthma action plan
- Lower ICS dose by 25-50% every 2-3 months
- DO NOT STOP ICS unless needed to temporarily confirm diagnosis

22
Q

Factors that increase asthma-related death

A
  • History of asthma requiring intubation and mechanical ventilation
  • Hospitalization <1 year
  • Recent oral steroid
  • Not currently using ICS
  • Psycho problems, allergies
  • Poor adherence
  • Comorbidities
23
Q

Outpatient self-management of asthma exacerbation

A

Increase usual reliever
Increase usual controller
Add oral steroid (call Dr)

24
Q

Mild-moderate exacerbation symptoms

A
  • Talking in phrases
  • Prefers sitting to lying
  • Not agitated
  • HR 100-120
  • Osat 90-95%
  • PEF >50%
25
Q

Severe exacerbation symptoms

A
  • Talking in words
  • Sitting hunched
  • Agitated
  • RR >30
  • HR >120
  • Osat <90%
  • PEF <50%
26
Q

Mild-moderate exacerbation treatment in primary care

A

SABA 4-10 puffs by MDI + spacer, repeat every 20 minutes for 1 hour
Prednisolone 40-50 mg
Controlled oxygen target 93-95%

After 1 hour, SABA 4-10 puffs q3-4h or 6-10 puffs q1-2h

27
Q

Mild-moderate exacerbation treatment inpatient

A

SABA +/- ipratropium
Controlled oxygen
Oral steroids

28
Q

Severe exacerbation treatment inpatient

A

SABA +/- ipratropium
Controlled oxygen
Oral steroids (can give IV if needed)
Consider IV magnesium (if persistent hypoxia, FEV1 <25-30%)
Consider high dose ICS (ED only, give on discharge)

29
Q

When should you consider ICU transfer?

A

Drowsiness, confusion, silent chest*
Continuing deterioration

30
Q

When could you consider discharge planning after a 1 hour reevaluation?

A

FEV1 or PEF 60-80%, symptoms improved

31
Q

When should you follow up with a patient after discharge?

A

1 week

32
Q

COVID considerations

A

Avoid nebulizers

33
Q

Exacerbation treatment monitoring

A

Steroids: glucose, WBC
Bronchodilators: HR, frequency
Wheezing, accessory muscle use, cyanosis
PEF/FEV/HR/Osat 3x daily

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