Asthma Flashcards

1
Q

What are the features of asthma on history

A

Wheeze
Cough
SOB
Chest tightness
Sx worse at night or early in AM
Atopic disorder - eczema, allergic rhinitis
Triggers: cold, exercise, viral illness, allergens, irritants, BB, NSAIDs, ASA, emotions

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2
Q

What are the features of asthma on exam

A

Usually normal
Prolonged expiration + expiratory wheeze
Silent chest = medical emergency
Kids - linear nasal creases, swollen nasal turbinates = allergic rhinitis

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3
Q

Features of asthma on spirometry

A

Pre and post bronchodilation = should see 12% improvement in FEV1 for Dx of asthma (250ml difference from baseline after bronchodilator)
FEV1/ FVC = less than 0.8 in kids, less than 0.7 in adults = restrictive airway disease
Can only be done >6 y/o
If under, trial inhaled corticosteroid for 8-12 weeks + PRN SABA
Dx if responsive
Only reliable when pt symptomatic - repeat if spiro negative
Other tests: peak flow (>20% change after bronchodilation), methylcholine solutions - can provoke bronchial restriction - watch for decrease in FEV1 by 20%, post-exercise decrease in FEV1 by 20%
CXR not indicated in diagnosis of asthma

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4
Q

Mild - mod - severe classification

A

Mild - PEF >70%
Moderate - PEF 50-70%, does not reverse
Severe - PEF <50%, RR >30, tachy >120, inability to finish sentences, pulsus paradoxus, cyanosis, silent chest, decreased LOC, ABG normal or elevated CO2

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5
Q

well controlled asthma features

A

Daytime sx <4 times weekly
Rescue puffer <4 times weekly
Nighttime sx <1 time a week
Physical activity unimpaired by sx
No asthma related absences from school or work
Exacerbations are mild and infrequent
FEV1/ PEF >90% of personal best
Diurnal PEF variation <10%

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6
Q

RF for severe asthma

A

Hx of severe exacerbation
Poorly controlled asthma
Comorbid atopic dz
Current smoker
Vit D deficiency

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7
Q

Rx for exacerbation

A

O2 if sats <92%
All: SABA - salbutamol w/ MDI, q20 mins in first hour
Mod-Severe: Ipratropium (short acting anti-cholinergic) 500mcg via neb or 4-8 puffs by MDI, q20mins for 1 hr then PRN for up to 3 hrs
If no response to initial rx: Prednisone 40-60mg PO in 1st hr. Can take 6 hrs to effect. Kids - 1mg/kg day
Severe + unresponsive: IV Magnesium sulphate 2g over 20 mins
Equipment + personnel for rapid intubation on hand

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8
Q

Criteria for admission

A

Unable to speak sentences
Tachypnea >25
Tachy >110
PEF <40%
Silent chest
Cyanosis
Confusion

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9
Q

Pharmacotherapy steps for asthma + what to ensure before stepping up

A

1) SYMBICORT (LABA/ ICS) PRN
2) BETHAMETHASONE (ICS) daily or MONTELUKAST (LTRA) daily
3) ADVAIR (LABA/ ICS)
4) ADVAIR + MONTELUKAST (ICS/ LABA + LTRA)
5) ADVAIR + MONTELUKAST + SPIRIVA (ICS/ LABA + LTRA + tiotropium)

Confirm correct dx
Continuing education
Check triggers + lifestyle interventions (pets, smoking)
Ensure compliance w/ meds + proper technique

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10
Q

As well as meds, what else is included in an asthma management plan

A

Self-monitoring - asthma plan w/ sx + at home PEF % of personal best (green, yellow, red zone)
Self-adjustment of medication
When to consult back (1-6 months depending on control)

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11
Q

When to refer

A

Children 1-5 w/ >2 exacerbations needing steroids
Children 6-11 who fail control on medium dose ICS
Recurrent need for oral steroids (>8/mo)
Diagnostic uncertainty
Need for environmental allergy testing
Suspected occupation related asthma

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12
Q

What is included in education and lifestyle adjustments?

A

Adherence w/ meds (barriers = cost, inhaler burden)
Ensure correct technique
Avoiding irritants/ triggers (smoking, wt loss, personal triggers (smoke, dust, viral URTIs, pet dander, NSAIDs, BB, emotions, exercise, cold air, GERD)

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13
Q

SABA - name, device, dose + SE

A

Salbutamol (Ventolin)
MDI = 1-2 puffs QID
Diskus = 1 puff QID
Tremor, tachycardia, HA

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14
Q

SAMA - name, device, dose + SE

A

Ipratropium (Atrovent)
MDI = 2 puffs TID-QID
Dry mouth, constipation, urinary retention

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15
Q

LABA - name, device, dose + SE

A

Formoterol
Turbuhaler = 6-12mcg BID

Salmeterol
Diskus = 1 puff BID

Tremor, tachycardia, HA

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16
Q

LAMA - name, device, dose + SE

A

Tiotropium (Spiriva)
Respimat = 2 puffs once day
Umeclidinium (Incruse)
Ellipta = 1 puff once day

Dry mouth, constipation, urinary retention

17
Q

LABA + LAMA - brand name

A

Inspiolto

18
Q

SAMA + SABA - name

A

Salbutamol + ipratropium (Combivent)

19
Q

LABA + ICS - names of 2 + SE

A

Formoterol + budesonide (Symbicort)
Salmeterol + fluticasone (Advair)

SE: Thrush + hoarseness, risk of PNA

20
Q

What PRAM score to give steroids at?

A

> 4

21
Q

PRAM score components

A

O2 sats, suprasternal retractions, scalene muscle contractions, AE, wheezing

22
Q

What to give w/ Mg in asthma?

A

Fluids

23
Q

What test can you do if spirometry is not conclusive for asthma?

A

Methacholin challenge test

24
Q

What can pts use along with SABA + ICS in mild asthma?

A

PRN formoterol/ budesonide