Asthma

Question 1

1 predisposing factor for asthma

Answer 1

Allergies (any)

recall: in pharm they said allergies has a genetic component to it too, so there is a slighttttt genetic component

Question 2

What drug class is the mainstay for asthma? “backbone”

Answer 2

Inhaled Corticosteroids

Question 3

two main pathophysiology components of asthma

Answer 3

Asthma = Inflammation + Bronchoconstriction

Question 4

Asthma Exacerbation Trmnt (ABCDE…M)

Answer 4

A- Airway O2 Nasal Cannula
B - Bronchodilator (SABA - Albuterol)
C - Corticosteroids
D - Drinking? IV Fluids
E - Epi
M - Magnesium

If all else fails -> INTUBATION

Question 5

a disease of diffuse** airway inflammation** caused by a variety of triggering stimuli resulting in partially or completely reversible bronchoconstriction

Answer 5

Asthma

Question 6

Environmental risk factors for asthma

Answer 6

Allergens -> dust mites, cockroaches, pets
Diet -> low in Vit C, Vit E, Omega-3 fatty acids. Obesity
Perinatal factors -> young maternal age, poor nutrition, prematurity, low birthwight, lack of breastfeeding

Question 7

Pathophys of bronchostriction in asthma

Answer 7

immune response -> chronically inflamed airway -> bronchial hyperreactivity -> airway remodeling

Question 8

Asthma triggers that aren’t obvi commen allergens

Answer 8

cold, dry air
Viral infx
exercise
emotions
GERD
Sulfites in dried foods or wine
Beta blockers
Aspirin, NSAIDs

Question 9

What is the one NSAID safe for asthmatics?

Answer 9

Celecoxib/Celebrex

Question 10

Pathophys of asthma attack

Answer 10

Trigger → reversible airway narrowing → increased histamines, prostaglandins, leukotrienes (overreactive immune response) → CO2 trapping → hyperventilation → visible respiratory distress (accessory muscles) → hypoxemia with elevated PaCO2 → respiratory acidosis → full respiratory failure

My notes: hypoxic regions are shunted off and fluids go to other parts of the body

Question 11

Wheezing that dissapears during an asthma attack means what?

Answer 11

they’re not moving air

Question 12

Confused pt stops wheezing mid asthma attack. WDYD?

Answer 12

INTUBATE!
stops wheezing = no air moving
Confusion 2ndary to hypoxia (low O2) and hypercapnia (high CO2)

Question 13

What is Pulsus Paradoxus?

Answer 13

Systolic BP drops >10mmHg when INHALING

Billman says: “bc overinflating your lungs puts pressure on your arteries -> decreases CO2”
I don’t think decr in CO2 would affect BP in this sort of pattern
Online source: “The pressure of the lungs decreases during inhalation, which is normal. A person with severe obstruction experiences an exaggerated response due to the decrease in the air pressure within the lungs, which further leads to a decrease in the systolic blood pressure”

Paradoxical = seemingly absurd or self-contradictory

Question 14

Vital Signs Indicative of SEVER ASTHMA

Answer 14

1. • Pulsus Paradoxus >18 mmHg
2. RR > 10
3. HR > 120 bpm (Tachy)

Other: prolonged expiration (3:1 to inspiration), having to sit up to breathe, inability to speak, accessory muscle use, nasal flaring, cyanosis, loss of wheeze

Question 15

Pertinent Asthma Hx Qs

Answer 15

How often:
symp are experiences
pt wake up at night
pt uses their SABA
asthma intereferes w/norm activity

Question 16

Asthma is classified by which 3 factors?

Answer 16

Question 17

Asthma WU

Answer 17

1. PFT
2. Spirometry
3. CXR if r/o others
4. Allx testing
5. Peak Expiratory Flow

Question 18

PFT Results

Answer 18

Obstructive pattern
Bronchodilator reversible

Question 19

Meds to hold prior to PFT

Answer 19

**8 hrs for SABA (Albuterol) **
24 hrs for SAMA (Ipratropium)
12-48 hrs for Theophylline
48 hrs for LABA (Salmeterol, Formoterol)
1 wk for LAMA (Tiotropium)

Question 20

Spirometry results

Answer 20

• DLCP (diffusing capacity for CO2) is norm or elev in asthma
• FEV1 & FEV1/FVC are reduced

DLCP is reduced in COPD. Diffusion of all gasses are reduced in COPD due to irreversible alveoli changes

Question 21

Which breathing test is ordered right before and after nebulizer during asthma exacerbation

Answer 21

Peak Flow
- determine their baseline max expiratory effort. Then, during an exacerbation, a 15-20% reduction indicates significant exacerbation.

Question 22

Asthmatic is using their SABA (Albuterol) more than 2x a week. Next step trmnt?

Answer 22

+ ICS

Question 23

Asthmatic on SABA PRN and ICS still experiencing symptoms. Next strep trmnt?

Answer 23

incr ICS dose
OR
+ ICS/LABA

Question 24

Cromolyn is only for ages ___

Answer 24

> 5yo

Question 25

Meds good for asthma with an allergic component

Answer 25

Montelukast (Singulair) - LTRA (Leukotreine Receptor Antagonist)

Monoclonal antibodies

Question 26

Albuterol SE

Answer 26

tremors, hypokalemia

Question 27

Theophylline SE

Answer 27

seizures (PAs dont Rx)

Question 28

Zileuton/Zyflo SE

Answer 28

Liver toxicity
Billman says DO NOT Rx

Question 29

When to use Monoclonal Antibodies

Answer 29

Allergic asthma Mod-sever persistent despite ICS trmnt in pts ≥ 6 yo

Pts require a (+) skin allergen test and IgE levels prior to dosing

Question 30

Asthma FU schedule

Answer 30

2-6 wk intervals for pts who are just starting therapy and req a set up regimen

6 month intervals after asthma is controlled, to continue monitoring

3 month intervals if step-down therapy is anticipated

Question 31

When to refer out for asthma?

Answer 31

Referral is req at Step 4 to Asthma/Allx specialist for Pulmonology

Question 32

Should asthmatics take tamiflu or relenza?

Answer 32

Tamiflu = GOOD; Relenza = BAD

Question 33

Should asthmatics get the intranasal flu vacc or the shot?

Answer 33

the live attenuated intranasal flu vaccine is contraindicated -> may induce wheezing or bronchospasms

Question 34

When is it okay to discharge home?

Answer 34

Discharge if → FEV1 or PEF post-trmnt ≥ 70% of personal best or predicted value AND if sustained improvement & stable ≥ 1hr