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Asthma Flashcards

1
Q

Disease: Big six

A

Presentation
Definition
Epidemiology
Etiology/pathophysiology
Diagnosis
Management

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2
Q

What do we assess when looking at presentation?

A

What does patient look like?

What are the characteristic signs and symptoms

history of present issues?

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3
Q

Textbook definition of presentation?

A

“Clinical manifestations”

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4
Q

Definition? (clinical assessment)

A

What defines disease state/what is it

(Not diagnosis)

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5
Q

Epidemiology? (question to keep in mind)

A

Condition common or rare?

Seasonal?

What population is at risk?

Incidence (ex. cases/100,000

Prevalence (ex. How many in a pop. of COPD)

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6
Q

Etiology/pathophysiology? (Thoughts during assessment)

A

How does it develop?

What condition gives rise?

How does it altar the the body

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7
Q

Diagnosis

A

How do we confirm?

What is appropriate testing?

What testing can help us rule out? (Imaging, labs)

What test match patient?

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8
Q

Disease management? (Clinical thoughts)

A

Acute or chronic

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9
Q

Asthma presentation

A

Dyspnea?
Symptoms come and go?
Wheezing?
Dry Cough?
Sign and symptoms have triggers?
Common colds week <
Allergy history?

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10
Q

GINA goal?

A

International in scope

Create guidelines for adults and children

Annual updates

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11
Q

NAEPP Stand for?

A

National Asthma Education & Prevention Program

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12
Q

NAEPP Goal?

A

National scope
Expert panels make recommendations

Panels create guidelines for diagnosis & management

Last updated Guidelines in 2020

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13
Q

GINA definition of Asthma

A

Heterogeneous disease

Characterized by chronic AW Inflammation

History of: wheezing, dyspnea, cough, & chest tightness

Confirmed expiratory airflow limitations

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14
Q

How many people in U.S. have Asthma?

A

25 million

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15
Q

Prevalence of asthma in 2020

A

7.8%

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16
Q

Correlation between Asthma and poverty

A

11% <poverty

6.7% >poverty

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17
Q

Percent of diagnosed w/ one or more exacerbations per year? (Asthma)

A

41%

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18
Q

How many suffer from asthma worldwide?

A

262 million

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19
Q

Deaths from asthma worldwide?

A

455,000 people

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20
Q

Host Risk factors for asthma?

A

Sex
Genetics
Obesity (BMI 30<)

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21
Q

Environmental factors for Asthma?

A

Allergens
Air pollution
Infection
Occupational sensitizers
Tobacco smoke
Active or passive smoke
Diet

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22
Q

Other risk factors for Asthma?

A

Drugs
Food additives & preservatives
Exercise induced
Gastroesophageal reflex
Nocturnal breathing disturbances
Emotional stress
Premenstrual asthma (catamenial asthma)
Allergic broncho-pulmonary aspergillosis

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23
Q

Why is Asthma difficult to define?

A

Definitions differ and change over time

Subtypes are defined differently by different authorities

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24
Q

Primary disorder of asthma

A

Smooth muscle constriction (bronchospasm)

Accumulation of thick whitish bronchial secretions

Bronchial wall inflammation (severe cases can lead to remodeling)

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25
How patient’s history defines asthma?
Wheezing SOB Chest tightness of chest Dry cough
26
Primary symptoms associated with Asthma
Tightness of chest dry cough wheezing Symptoms come and go SOB Symptoms that respond to triggers Prolonged, persistent colds Allergy history
27
Expiratory flow limitations with Asthma?
Volume in usually ⬇️ Flow is okay
28
Define Asthma phenotype
A set of characteristics that are used to define the type of asthma
29
Out of 4,145 asthma deaths, how many over 18 yrs old
3,941
30
Eosinophils role in Asthma?
Granules break open and cause inflammation
31
How do alveoli’s become hyper-inflated or collapsed due to mucus plugging?
Mucus plug can cause air trapping causing hyperinflation Mucus can also obstruct air from leading to the alveoli which can cause atelectasis
32
Why are Asthma features reversible?
Because they are symptom induced, so when the symptoms subside the symptoms will decrease.
33
Why do airways remodel
Eventually the pt. Smooth muscle will thicken and AW walls will develop a chronic inflammation.
34
Asthmatic wheezing vs others
Polyphonic During exhalation Vary in tone Start and stop independently High pitched Throughout lungs Musical
35
Describe the forced vital capacity test?
Inhale deeply and exhale forcefully
36
Forced vital capacity test vs slow vital capacity test?
Forced invokes more turbulence and resistance which will reduce volume Slow vital capacity reduces speed of flow to reduce airway resistance
37
What is FEV1
The most the patient can forcefully exhale in the first second.
38
Improvement of FEV1 after bronchodilator that marks improvement?
>12% or 200mL
39
Improvement in FEV1 after anti-inflammatories that indicate improvement?
>12% or 200mL
40
Two goals of Asthma management by GINA
Symptom control Reduction of exacerbation risk
41
GINAs circular approach to asthma management
First review what symptoms the patients has Assess and Confirm a diagnosis and symptom control. Also, risk factors and pt. Technique. Go over goals Adjust treatment of modifiable risk factors. Come up with non-pharmacological strategies including ICS education and skills
42
Describe role of “controller” meds
Maintenance/ management of symptoms
43
Describe role of reliever meds?
Rescue/Reduce exacerbation
44
What are add-on medications needed?
Controller medication at high doses after exacerbations still break through
45
Role of ICS-Formoterol in current GINA guidelines
As needed/maintenance
46
(Preferred) Stepwise of GINA management?
A Symbicort will be give given as needed (1-2) Low dose Symbicort as maintenance (3) Medium dose of Symbicort maintenance (4) Add LAMA (5)
47
(Alternative) stepwise GINA management
ICS taken when SABA is (1) Low dose maintenance ICS (2) Low dose maintenance ICS-LABA (3) Medium/high dose maintenance ICS/LABA (4) Add-on LAMA (5)
48
Variability in airways throughout day between asthma and normal AW?
Normal: 6% Asthma: 30%
49
What’s inside eosinophil granules?
Chemical mediators toxic to invaders and the cell
50
What is observed on a slide after granules breakdown?
Charcot-Leiden crystals
51
Three test that confirm variable airflow without provoking symptoms
Positive bronchodilator responsiveness test (12% or greater FEV1) Trial of Anti-inflammatories(12% or greater) Variability in diurnal PEFR (30%)
52
Test to confirm airflow variability that provoke symptoms
Positive exercise challenge (just measure decrease in lung function) Positive bronchial challenge (equal to greater than 20% in FEV1)
53
Why is FEV1 better
It is a the initial and probably higher volume Vol/sec
54
Why objective measures aren’t appropriate for asthma diagnosis ?
patients may not be able to replicate symptoms at the time of the test.
55
Physical signs expected to be seen during exacerbation? (Emphysema)
Accessory muscle use (especially expiratory) Pursed lip breathing Tachycardia Tachypnea Hypertension
56
Define pulsus paradoxus
BP drops during inspiration (SBP >10) BP increases during expiration
57
What capacity increases with Asthma exacerbation?
Functional Residual Capacity (Hyperinflation)
58
What inspiratory flow markers decrease with exacerbation of COPD?
Peak Expiratory Flow Rate
59
What is observed in sputum?
Charcot-Leyden Casts of mucus from small AWs High IgE levels (in extrinsic asthma)
60
What is observed on radiographs?
Increase translucent Depressed diaphragms Increased AP (young patients)
61
Symbicort generic name?
Budesonide and formoterol
62
Dulera generic name?
Mometasone and Formoterol
63
What is the role of leukotriene receptor antagonist?
Blocks receptor site on inflammatory cells for leukotrienes
64
Widely known leukotriene inhibitor?
Montelukas (singulair)
65
What is the commonly used LAMA by GINA
Tiotropium bromide
66
Seebri Neohaler generic name?
Glycopyrrolate
67
Incruse Ellipta generic name?
Umeclidinium bromide
68
What are biologic controllers used for step five?
Anti-IgE agent Anti-interleukin 5 Anti IL-4 Anti-TSLPR
69
Anti-E used for step five?
Omalizumab
70
What is an asthma action plan used for?
Improve asthma monitoring and control
71
When does GINA say prepare for intubation?
During exacerbation: Drowsiness Silent chest Confusion
72
Symptoms Severe exacerbation? (Asthma)
Speaks in one word Sits hunched forward Agitated RR >30 Accessory muscles HR >120 Sat <90 PEF = or < 50% expected
73
Mild exacerbation signs? (Asthma)
Talks in phrases prefers sitting or lying Not agitated RR just increased No accessory muscle use HR 100-120 Sat 90-95% PEF >50% expected
74
Definition of Asthma presentation of exacerbation?
Episodes characterized by: Progressive increase of dyspnea Cough Wheezing Chest tightness Progressive decrease in lung function
75
Medication and maintenance during mild exacerbation of asthma?
SABA Consider ipratropium bromide O2 93-95 Oral corticosteroids
76
Medication and maintenance during severe exacerbation?
SABA Consider ipratropium bromide O2 93-95 Oral or IV corticosteroids Consider IV magnesium Consider high dose ICS
77
Magnesium use?
Associated with calcium channel blockade Given IV Evidence is mixed
78
Heliox
Given by Nebulizer with less dense gas to reduce airway resistance Helium takes the place of N2 Controversial
79
What is methylxanthines?
A controller
80
A methylxanthines to remember?
Theophylline
81
Other names for theophylline?
Theochron, Elixophyllin, Theo-24
82
Other test to confirm asthma?
FeNo test (rise with eosinophil AW inflammation) Complete blood count Fractional concentration of exhaled nitric oxide

Disease (3 decks)

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