class 7 asthma

Question 1

what is asthma

Answer 1

inflammation fo the airways characterized by paroxysmal or persistent symptoms such a dyspnea, wheezing, sputum production and cough

Question 2

what happens in the airways with asthma

Answer 2

-airway is more irritable or “twitchy”
-chronic inflammation
-excessive mucus production
-airway remodeling

Question 3

what are the symptoms of asthma

Answer 3

-chronic cough
-wheeze
-chest tightness
-shortness of breath

Question 4

when do symptoms occur?

Answer 4

-worse at night/morning
-with viral respiratory infection
-after exposure to allergens
-after exercise
-after playing/laughing

Question 5

comorbidities for asthma

Answer 5

-allergic rhinitis
-chronic sinusitis
-GERD
-obesity

Question 6

how is asthma diagnosed in children <6 years of age

Answer 6

-clinical history of recurrent symptoms
-improvement in symptoms with therapy
-no suspicion of alternative diagnosis
-family hx of asthma, allergies, and/or eczema

Question 7

how is asthma diagnosed in children > 6 years and adults

Answer 7

-clinical history
-pulmonary function test (PFT)
-methacholine challenge test

Question 8

what is pulmonary function test (spirometry)

Answer 8

-preferred diagnostic test
-measure how much and how fast you can blow air out of your lungs
-FEV1 improves >12% after bronchodilator or >20% after 2 weeks of inhaled steroid

Question 9

what is a methacholine challenge

Answer 9

-perform baseline spirometry first
-increasing concentrations of methacholine given via neb. FEV1 is measured after each inhalation (>20% change is significant)
-measures airway hyperresponsiveness

Question 10

education needed for people dx with astma

Answer 10

-what it is
-identify triggers/discuss avoidance
-reliever therapy prn
-medications daily
-inhaler technique
-adherence to meds
-written action plan
-regular assessments of asthma control

Question 12

non-allergic triggers (irritants)

Answer 12

-dust
-exercise
-tobacco smoke
-wood smoke
-strong scents
-viral infections
-weather changes
-air pollution

Question 13

environmental control outside of the home

Answer 13

-plan ahead
-avoid smoke/vapour
-remove pets

Question 14

home environmental controls

Answer 14

-mold/mildew removal
-no carpets
-hypoallergenic mattress/pillow cover
-bed linen washed 1x week
-humidity

Question 15

education for exercise-induced asthma

Answer 15

-warm-up before
-cool down after
-use bronchodilator 10-15 minutes before
-avoid outdoor exercise when pollution/pollen count is high
-cover mouth and nose when exercising in cold
-always carry blue puffer (bronchodilator)

Question 16

reliever medications for asthma

Answer 16

-short acting bronchodilators (ventolin, bricanyl)
-used PRN to tx acute s&s
-relax tightened muscles around the airways allowing them to open up
-work in 10-15 mins lasts 4h
-side effects: inc HR & tremors, may develop tachyphylaxis is used too regularly

Question 17

controller medications for asthma

Answer 17

-anti-inflammatory steroids (flovent, pulmicort, alvesco, qvar, asmanex)
-used DAILY
-used if 1 or more indicators of poor control
-controls swelling and mucus production inside the airways
-works slowly
-side effects: thrush, hoarseness, mild decrease in growth (monitor ht &wt)

Question 18

combination medication for asthma

Answer 18

-inhaled steroid and long acting beta agonist (advair, symbicort, zenhale)
-used on a daily basis
-control swelling inside the airway and relaxes tight muscles on the outside airway
-symbicort & zenhale only in children 12+

Question 19

leukotriene receptor antagonist for asthma

Answer 19

-class of anti-inflammatory (singulair, montelukast)
-taken orally, daily, in the evening

Question 20

prednisone for asthma

Answer 20

anti-inflammatory
-used to treat acute exacerbations
-given orally for 3-7 days
-dose 1mg/kg/day

Question 21

how to use aerochamber with mask for med delivery

Answer 21

-open inhaler cap
-shake 10 times
-insert inhaler into spacer
-place and seal mask over nose/mouth
-press down on inhaler once
-take 6 breaths
-wait 30 sec to repeat if needed
-rinse & spit after medication, wash face

Question 22

how to use aerochamber with mouthpiece

Answer 22

-open inhaler cap
-shake 10 times
-insert into spacer
-breath out, seal lips around mouthpiece
-press down on inhaler once
-take a slow deep breath hold 10s (or 6 normal breaths)
-wait 30s to repeat if needed
-rinse n spit

Question 23

how to use turbuhaler

Answer 23

hold upright
-twist opne & remove cover
-turn coloured base counter clockwise
-turn base back to click
-breath out AWAY from device
-seal lips around mouthpiece
-take a quick deep breath & hold 10s
-wait 30s to repeat if needed
-rinse n spit
-replace cover

Question 24

how to use diskus

Answer 24

-push open with thumb
-slide lever away from you until a click is heard
-breath out away from diskus
-seal lips around mouthpiece
-take a full deep breath in hold 10s
-close
-rinse n spit

Question 25

canadian guideliens for good asthma control

Answer 25

daytime s&s: <4 days/week
nightime s&s: <1 night/week
-exercise: normal
-exacerbations: mild, infreq
-school absence: none
-bronchodilator use: <4 dose/week
-FEV 1: >90% personal best
-PEF: >90% personal best

Question 26

asthma education goals

Answer 26

-prevent exacerbations
-improve quality of life & ADLs
-reduce airway damage & med side effects
-reduce morbidity & mortality
-reduce health care costs