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Flashcards in Asthma Deck (67)
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Define Asthma

A chronic inflammatory disorder of the airways. Variable and recurring symptoms. Airflow obstruction. Bronchial hyperresponsiveness. Underlying inflammation


Pathophysiology of air flow obstruction

airway narrowing increases resistance. loss of elastic recoil of the lung decreases driving pressure. Inflammation of the airways due to mucosal edema
and increased mucous production


What happens as a result of persistent inflammation?

Goblet cell hypertrophy .Mucus hypersecretion. Loss of ciliated epithelium. Squamous metaplasia
Destruction of alveolar walls. Peribronchiolar fibrosis


What are causes of airflow limitations?

Bronchoconstriction. Bronchial smooth muscle contraction in response to exposure to a variety of stimuli


What causes airway hyperresponsiveness?

Exaggerated bronchoconstrictor response to stimuli


What causes airway edema?

Edema, mucous hypersecretion, formation of thickened mucous plugs



Cough.Wheezing (end expiratory). Shortness of breath. (symptoms may have a seasonal and/or diurnal variations)


Inflammatory response involves which cells

mast cells, t-lymphocytes, macrophages, eosinophils and epithelial cells.


What is the role of eosinophils in astha?

release granular protein that damages bronchial epithelium and promotes airway hyper-responsiveness.


What is the role of lymphocytes in asthma?

produce Cytokines, Leukotriene B-4 and C-4, prostaglandin and histamine.


What is the role of Mast Cells in asthma?

initiate arousal condition in IgE receptors


What do Leukotrienes (Potent Inflammatory Mediators) do?

Increase vascular permeability/edema.Increase mucus production.Decrease mucociliary transport.
Inflammatory cell recruitment


Asthma Classic triad

Chronic episodic dyspnea
Chronic cough


Asthma Associated Symptoms (during attack)

Tachypnea, tachycardia, and systolic hypertension
Audible harsh respirations, prolonged expiration, wheezing
Sputum production
Chest pain or tightness
Diminished breath sounds during acute exacerbations


When can symptoms be worse

At night


Diagnosis of Asthma

Signs and symptoms suggestive of asthma
Confirmation of variable expiratory airflow limitation, preferably by spirometry
Exclusion of alternative diagnoses


When should you use spirometry?

Order before and after bronchodilators. Or can have pt monitor peak flows at home for a month and keep diary of symptoms.


How would you work up asthma in clinic visit?

Can do a quick challenge in the office with a peak flow meter before and after a bronchodilator.
Chest xray only if you need to exclude other causes or if you are suspecting new onset asthma in a middle aged adult


Asthma DDx

Foreign body ingestion
Congestive heart failure
Pulmonary embolism
Panic disorder, hyperventilation syndrome
Pneumonia, bronchitis
Alpha1-Antitrypsin Deficiency
Vocal Cord Dysfunction
Cough secondary to drugs (ACE inhibitors)


Describe Atopic Extrinsic Asthma

Most common. Onset is usually the first two decades of life. Associated with other allergic manifestations and Family history. Serum IgE and eosinophil count are usually elevated


How is asthma managed?

Routine monitoring. Patient education.Control of triggers and comorbid conditions. Pharmacologic therapy


Peak Flow

used to measure how well air moves out of the lungs. Measures how fast air comes out of the lungs with forceful exhalation after inhaling fully.


Benefits of Peak Flow measurments

Learn what triggers their asthma
Decide if the asthma action plan is working
Decide when to add or adjust asthma medications
Know when to seek emergency care
can help providers and their patients monitor their asthma.
Can help the patient when their asthma is getting worse
Peak flow may show changes before the patient feels them.


Green Zone

80 to 100 percent of the patients usual or "normal" peak flow rate signals all clear
A reading in this zone means that your asthma is under reasonably good control. It would be advisable to continue your prescribed program of management.


Yellow Zone

50 to 80 percent of the patients usual or "normal" peak flow rate signals caution. It is a time for decisions.
Your airways are narrowing and may require extra treatment. Your symptoms can get better or worse depending on what you do, or how and when you use your prescribed medication. You and your provider should have a plan for yellow zone readings.


Red Zone

Less than 50 percent of the usual or "normal" peak flow rate. Severe airway narrowing may be occurring. Take your rescue medications right away. Contact your provider now and follow the plan he/she has given you for red zone readings.


Contributing factors to Asthma

Inhaled allergens (medical rx and avoidance)
Food allergies? Tobacco smoke (first and second hand). Rhinitis/sinusitis.GERD.Occupational exposures. Viral respiratory infections


What does leukotriene 4 (LTD4) do?

profound bronchoconstriction, about 1000 x more potent than histamine


What is the “bronchoprovocation test”?

inhalation of irritating agent such as metacholine used if spirometry was normal, but asthma is still suspected diagnosis


What type of medications are used for quick relief of asthma symptoms?

Short-acting beta-2 agonists and anticholinergics