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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is the definition of asthma?

A

Chronic inflammatory lung disease that is associated with cough, dyspnea, and wheezing

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2
Q

What are the three characteristics of asthma? Which has to be found for a diagnosis of asthma?

A
  • symptoms of cough, dyspnea, and wheezing
  • Reversible airway narrowing
  • Increased airway responsiveness to stimuli
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3
Q

What is the most common chronic childhood disorder in first world countries? What generally happens as these children age?

A

Asthma

If resolves after adolescence, then does not usually come back

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4
Q

What is the trend of hospitalization and mortality rates secondary to asthma?

A

Increasing

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5
Q

What ethnicity is more likely to die from asthma?

A

Blacks

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6
Q

What are the risk factors for developing asthma? (4)

A
  • Atopy
  • Indoor allergen exposure
  • Rhinitis
  • Occupational exposures
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7
Q

What is atopy?

A

IgE mediated predisposition to developing allergic reactions

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8
Q

What are the four common indoor allergens that can cause asthma?

A
  • House dust mites
  • animal proteins
  • cockroach antigen
  • alternaria mold
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9
Q

Early or late menarche is a risk factor for asthma?

A

Early

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10
Q

What is the association between smoking and asthma?

A

Smoking exposure, including prenatally, predisposed to asthma

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11
Q

What is the associated between weight and asthma?

A

Obesity predisposes to asthma

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12
Q

What is the relation between maternal age and asthma?

A

Increasing maternal age increases asthma incidence

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13
Q

What is the primary pathological finding associated with asthma?

A

airway obstruction d/t combination of inflammation and cellular infiltration

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14
Q

True or false: respiratory infections may predispose to asthma

A

True

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15
Q

True or false: the degree of inflammation of the airways poorly correlates to the degree of asthma

A

False–correlates well

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16
Q

What are the three identifiable histological findings with asthma?

A
  • Infiltration of the airway with eosinophils
  • Upregulated proinflammatory cells
  • Alterations in the non-cellular components of the airway wall
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17
Q

What causes the infiltration of eosinophils in the airways of asthmatics?

A

Mast cell antigen release

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18
Q

What cause the reduced response to medication in asthmatics?

A

Bronchial wall remodeling

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19
Q

What are the four major inflammatory mediators of asthma?

A
  • Histamine
  • Leukotrienes
  • Kallikrein
  • Platelet activating factor
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20
Q

What are the four components of asthma airway obstruction?

A
  • Inflammation
  • Smooth muscles contraction/hypertrophy
  • Mucus gland hypersecretion
  • Airway remodeling
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21
Q

What are the three major drugs that are asthma triggers?

A

ASA
NSAIDs
Beta blockers

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22
Q

What causes cold air asthma?

A

Acute cooling of the airway triggers irritant receptors

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23
Q

What are the three cardinal symptoms of asthma?

A

Cough
Wheezing
Dyspnea

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24
Q

When is dyspnea especially prominent with asthma?

A

After exertion or at night

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25
Q

When is cough especially prominent with asthma?

A
  • after exertion
  • Breathing cold air
  • at night
26
Q

What causes the exacerbation at night of asthma?

A
  • Lower levels of endogenous circulating corticosteroids

- Increases in histamine

27
Q

Is the cough with asthma productive?

A

Not unless infected

28
Q

Is wheezing diagnostic for asthma?

A

No

29
Q

What happens to the intensity of the breath sounds with asthma?

A

Decreased

30
Q

How do you diagnose asthma?

A

Clinical features

c/w obstructive

31
Q

What are the three major tests to diagnose asthma?

A
  • Bronchoprovocation
  • Pre and post bronchodilator spirometry
  • Serial peak flow measurements
32
Q

What is the MOA of methacholine?

A

Stimulates M3 receptors in the bronchi, causing asthma

33
Q

What happens to the peak flow rate with asthma?

A

Decreased

34
Q

What are the major pitfalls of provocation testing? (2)

A
  • False positive if recent URI

- False negative if on meds

35
Q

Does bronchial hypersensitivity alone indicate the presence of asthma?

A

No–sensitive, but not specific finding

36
Q

What are the three criteria to asses the severity of asthma?

A
  • Days with ssx
  • Nocturnal ssx
  • Peak flow rates/variability
37
Q

What patients can be treated with a PRN rapid acting beta agonists only? If this is not true, what must be added to the drug regimen?

A

Patients with intermittent ssx:

  • less than 2 days/week
  • less than 2 nocturnal awakening per month

If more than that, then need an anti-inflammatory

38
Q

What are the goals of care with asthma therapy? (5)

A
  • Freedom from frequent ssx
  • minimal need for beta agonists
  • Optimize lung fx
  • Maintain normal daily activities
  • Satisfaction with asthma care
39
Q

Diurnal variation in peak flows of greater than what percent is considered diagnostic for asthma?

A

More than 20% on 3 or more days

40
Q

When are anticholinergics used for treating asthma?

A

Refractory emergencies

41
Q

Why are theophylline drugs not used much anymore?

A

Drug interactions

Narrow therapeutic range

42
Q

What is the major antibody that can be used to treat asthma? MOA?

A

Omalizumab–anti IgE

43
Q

What is the mainstay of treatment for long term asthma?

A

Inhaled corticosteroids

44
Q

What is the indication for systemic corticosteroids? What must be done if these patients receive this therapy?

A

bad asthma, but need to taper

45
Q

Is there any benefit of using a nebulizer vs an albuterol metered inhaler?

A

No

46
Q

When are levo-beta agonists used?

A

Only if the pt has sensitivites

47
Q

Why is it inappropriate to use monotherapy of a long acting beta agonist for asthma?

A

Risk for sudden cardiac death

48
Q

What is the MOA of ipratropium?

A

Anticholinergic for asthma (“I pray I can breathe again”)

49
Q

When should an inhaled steroid be administered to patients with asthma? How should this be administered?

A

When they have greater than intermittent asthma

Should be used in a stepwise fashion

50
Q

What are the side effects of inhaled corticosteroids? Are there systemic effects?

A

Oral thrush, but no systemic effects

51
Q

When is systemic corticosteroids indicated for asthma? What corticosteroid is usually used?

A

Acute exacerbations

Prednisolone

52
Q

When should anti-inflammatories be used with asthma treatment?

A

More than intermittent asthma (after step 1)

53
Q

What is the treatment for emergent asthmatic episodes?

A
  • Oxygen
  • Neb every 20 minutes
  • Ipratropium if severe
54
Q

Why is hydration important for asthma treatment?

A

Reduce mucus thickness

55
Q

What are the two leukotriene blockers used to treat asthma? Which leukotriene receptors do they block?

A

Zileuton
Zafirlukast

LTD4 receptors

56
Q

What cells release leukotrienes in asthmatic patients?

A

Eosinophils

57
Q

What happens to wheezing with progression of an acute asthma exacerbation?

A

Gets less loud

58
Q

How bad is the asthma if there is accessory respiratory muscle use?

A

Moderate to severe

59
Q

When does oxygen saturation fall with an asthma exacerbation?

A

moderate falls a little (low 90s)

Severe falls a lot (below 90%)

60
Q

What happens to HR as asthma gets worse?

A

tachycardia to bradycardia when respiratory arrest is imminent

Respiratory (34 decks)

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