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Q3 Clin Med II Test 2 (Resp) > Asthma > Flashcards

Flashcards in Asthma Deck (31)
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1
Q

Asthma definition?

A

OBSTRUCTIVE
Chronic inflamm of airways,
Intermittent obstruction (U) reversible,
Hyper-reactive airway

2
Q

Asthma risk factors?

A
Hx of atopic dz
Family hx
Tobacco exposure
GERD
RSV
Vocal chord dysfxn
3
Q

Asthma sxs?

A
dyspnea
cough (> in p.m.)
wheeze
tight chest
exacerbated w/ triggers
4
Q

Asthma initial approach:

New?

Existing?

A

Establish baseline

New:
nocturnal sxs, risk fxr/triggers, recent URI

Existing:
inhaler frequency, ER visits, hospitalization, intubation, lifestyle Δs

5
Q

Asthma presentation?

A
Expiratory wheeze
Prolonged expiration
Tachypnea
Tachycardia (U) from abuterol use
Accessory mm use
Atopic dz
Pulsus paradoxus (↓ pulse on inspiration)
6
Q

Asthma initial diag w/ PFT?

A

> 12% in FEV1 w/ bronchodilator

methacholine challenge: FEV1 ↓ by 20% (can be false +)

7
Q

Asthma monitoring?

A

spirometry response to tx

8
Q

Asthma classification in steps: Step 1?

A

intermittent, all ages

sxs < 2/wk
< 5yo
N PFT in b/w sxs
brief exacerbation
FEV1 >80%
9
Q

Asthma classification in steps: Step 2?

A

mild, persistent

sxs >2/wk
0-4yo: >2 nights/mo
>5yo: 3-4 nights/mo
minor activity limit
FEV1 >80%
10
Q

Asthma classification in steps: Step 3?

A

moderate, persistent

sxs daily
0-4yo: 3-4 night/mo
>5yo: >1 night/wk
exacerb >2/wk, lasts days, ↓ activity
FEV1 60-80%
11
Q

Asthma classification in steps: Step 4?

A

severe, persistent

sxs always
0-4yo: >1 night/wk
>5yo: (U) every night
↓↓ activity
FEV1 <60%
12
Q

Asthma meds?

A

B2 agonists (short and long acting) SABA, LABA

Corticosteroids (inhaled or systm) ICS, SCS

Anticholinergics

Leukotriene Receptor Antagonists (LTRA)

13
Q

Tx for Step 1, children?

For Step 2, children?

A

short B2 agonists PRN

low-dose ICS + SABA

14
Q

Tx for Step 3, children?

A

refer
0-4yo: med-dose ICS
5-11yo: med-dose ICS OR low ICS + LTRA/LABA

15
Q

Tx for Step 4, children?

A

0-4yo: med-dose ICS + LABA/LTRA

5-11yo: med-dose ICS OR low ICS + LABA

16
Q

Tx for Step 5, children?

A

0-4yo: high-dose ICS + LABA/LTRA

5-11yo: high-dose ICS + LABA

17
Q

Tx for Step 6, children?

A

all ages: high-dose ICS + LABA + oral steroids

18
Q

Assessing asthma control, children: Rule of 2s

A

Rule of 2s:
>2/wk,
>2 nights/mo,
quick meds >2/wk

19
Q

Well-Controlled in children =

A

<1 night/mo

20
Q

Not Well-Controlled in children =

A

0-4yo: >2/wk, >1 night/mo

5-11yo: >2/wk, >2 night/mo

21
Q

Poorly Controlled in children?

A

All: throughout day
0-4yo: >1 night/mo
5-11yo: >2 night/mo

22
Q

Tx for Step 1, adults:

Controller?

Rescue?

A

Controller: Φ

Rescue: SABA (albuterol)

23
Q

Tx for Step 2, adults:

Controller?

Rescue?

A

Controller: low-dose ICS OR LTRA

Rescue: SABA (albuterol)

24
Q

Tx for Step 3, adults:

Controller?

Rescue?

A

Controller: low-dose ICS + LABA (advair)
OR med-dose ICS

Rescue: SABA (albuterol)

25
Q

Tx for Step 4, adults:

Controller?

Rescue?

A

Controller: med-dose ICS + LABA (advair)
OR med-dose ICS + LTRA/theophyl

Rescue: SABA (albuterol)

26
Q

Tx for Step 5, adults:

Controller?

Rescue?

A

Controller: high-dose ICS + LABA (advair)
AND Xolair for allergies

Rescue: SABA (albuterol)

27
Q

Tx for Step 6, adults:

Controller?

Rescue?

A

Controller: high-dose ICS + LABA (advair) + oral steroids
AND Xolair for allergies

Rescue: SABA (albuterol)

28
Q

Acute asthma attack: Peak Expiratory Flow predicts severity

Mild?

Mod?

Severe?

Emergency?

A

Mild: PEF >70% (outpt)

Mod: PEF 40-69% (ER)

Severe: PEF <25% (ICU)

29
Q

Acute asthma attack: ABG findings?

A

(C): resp alkalosis from hypervent/hypocapnia

Ominous: normal Pco2, tired pt

30
Q

Acute asthma attack: ECG monitoring?

A

watch for long QT interval (hypoK+ from B-agonist use)

31
Q

Acute asthma attack: tx?

A
Small Vol nebulizer (albuterol)
Oral/IV steroids if PEF <50%
Abx only for penumonia
Resp monitoring
Intubation