Asthma Flashcards by Sean Osborne

What cells are involved in an asthma attach?

mast cells, Eosinophils, neutrophils, T-lymphocytes, macrophages, epithelial cells

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Can asthma be reversed

yes spontaneously or with treatment

this is a big difference because you can not reverse COPD

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what are Asthma risk factors

Innate Immunity
Host factor- genetics
Environment Factors

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what are some symptoms of asthma

Wheezing

History of cough thats worse at night, trouble breathing

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When do the symptoms of asthma tend to get worse

Exercise  Viral infection
Inhalant Agents   Irritants
changes in weather
emotional response
Stress
Menstrual cycles

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How is Asthma diagnosed

episodic symptoms of airflow obstruction or hyperresponsiveness
Airflow obstruction is at least partially reversible
FEV1 of >200ml and >or= 12% from baseline measure after SABA

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What are the goals of Asthma therapy

Reduce impairment
prevent symptoms
require infrequent use of SABA
maintain norm. pulm function
maintain norm. activity levels
meet pt's and Fams expectations and satisfaction with asthma care

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How do you reduce the risk of asthma with therapy

prevent exacerbations and minimize ED visits
prevent loss of lung function
prevent reduced growth lung growth
provide optimal pharmacotherapy

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what drugs belong to SABA beta 2 agonist?

Albuterol
Levabuterol
Pirbuterol

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using a SABA more than 2 days a week indicated what

need to begin long term control medications

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Ipratropium

Anticholinergic
not the preferred agent
Can not use in Pts under 12
MDI-2puffs every 6 hours
Take longer to work
More Side effects

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Albuterol & ipratropium combo dosing for
MDI-metered dose inhaled
Neulizer

MDI- 1inh every 6 hours

Neb: 3ml every 6 hours

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Why are low does inhaled corticosteroids preferred treatment for step 2

decreased the number and activity of inflammatory cells (better at reducing inflammation from eosinophils& neutrophils
Inhibit bronchoconstrictor mech.

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What are the side effects of Inhaled steroids

cough, dysphonia, oral thrush

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what are the effects of high does inhaled steroids

Adrenal suppression
Osteoporosis
skin thinning
easy bruising
cataracts

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what are the effects of low dose inhaled steroids

growth suppression in children

growth velocity may be altered

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What are Inhaled corticosteroids

Budesonide
Fluticasone
Mometasone
Ciclesonide
Beclomethasone

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What are step 2 alternatives to low dose inhaled steroids

age>12

Mast cell stabilizers: cromolyn (now only used via nebulizer)
nedocromil
LTRA(more effective)
montelukast, Zafirlukast
Theyophilline( has a lot of side effects) related to caffeine narrow therapeutic index

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How do mast stabilizers work?

stabilize mast cells
block chloride channels
can be used as preventative therapy for exercise unknown allergies
great safety profile but questionable efficacy

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What are LTRA drugs

Montelukast or Zafirlukast

they interfere with leukotriene mediators

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What are things to watch for with people who are on LTRA

Think they start with L so they affect the liver (ALT)
hepatitis
Can cause depression in children (kids want to jump off a mountain)

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How does Zafirlukast interaction and CYP problems

food decreases bioavailability
CYP 2C9 inhibitor
increased warfarin levels

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what is theophylline metabolized by?

CYP1A2 & CYP3A4

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What is used for step 3 in asthmatics

age>12

Medium dose ICS (1st)
or 
Low dose ICS & LABA
or 
Low dose ICS+LTRA,theophylline, Zeluton

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what is really important about using a LABA

it has no anti-inflammatory properties never use as mono therapy

What is the black box warning with LABAs

increased risk of asthma exacerbation and asthma related death with regular use of LABA

what are two kinds of LABAs

Salmeterol and Formoterol (faster think stars with F like F1 race car)

what is so special about mometasone

you only need to take it once

what should be used in Step 4 asthma | age>12

medium dose+LABA or Med dose ICS+LTRAorTheophylline, or Zileuton or Tiotropium

what to use with step 5 asthmatics | Age>12

High dose ICS+LABA and consider omalizumab

what to use with step 6 asthmatics | Age>12

High dose ICS+LABA+ oral steroid and consider omalizumab

how does omalizumab work

bind to portion of IgE antibody preventing the binding to its high affinity receptor on mast cells and basophils

what are some adverse effects of omalizumab

urticaria and anaphylaxis

what are some oral steroids

prenisolone, prednisone, methylprenisolone

what are some non-pharmacologic treatment

``` avoid triggers remove carpet vacuum windows closed air filters ```

what is the first line treatment for exercise induced bronchospasms

SABA

what is second like for EIB

LTRA

what is the last line for EIB

cromolyn

If a patient has asthma and GERD how do you treat them

treat the GERD because it is often that if you stop it that will relieve the asthma symptoms

what are COPD risk factors

``` smoking alpha1 antitrypsin occupation air pollution infection socioeconomic status ```

what is the hallmark of COPD

dyspnea

what are some other classic symptoms of COPD

chronic cough | sputum production

what are the two 24 hour long acting LABA

vilanterol | indacterol

what is a 12 hour acting LABA

arformoterol

Why is tiotropium a better anticholinergic

more selective and has a higher affinity for muscarinic receptor

what has been shown to increase survival in chronic respiratory failure?

oxygen | need to have levels >90%

In COPD patients who experience exacerbations what is first line treatment

oxygen 1st then SABA 2nd line-short acting anticholinergic steroid

what 3 cardinal symptoms must present for use of antibiotics in an exacerbation

increased dyspnea sputum volume sputum purulence only need two of the 3 symptoms if purulent sputum is one of them or a person on a ventilator

how long do you give the antibiotics for?

7-10 days

what are the nighttime awakenings for intermittent ages 5yo> what is their stage?

less than or = 2 | Step 1

what are the nighttime awakenings for mild ages 5yo> what is their stage?

3-4x/month | step 2

what are the nighttime awakenings for moderate ages 5yo> what is their stage?

>1x/week but not nightly | step 3

what are the nighttime awakenings for severe ages 5yo> what is their stage?

7x/week | step 4or5

what are the nighttime awakenings for intermittent ages 0-4yo what is their stage?

0 | stage 1

what are the nighttime awakenings for mild ages 0-4yo what is their stage?

1-2x/month | step 2

what are the nighttime awakenings for moderate ages 0-4yo what is their stage?

3-4x/month | step 3

what are the nighttime awakenings for severe ages 0-4yo what is their stage?

>1x/week | step 3

For ages 0-4 what is step 1 asthma treatment

SABA

For ages 0-4 what is step 2 asthma treatment

Low dose ICS

For ages 0-4 what is step 3 asthma treatment

medium dose ICS

For ages 0-4 what is step 4 asthma treatment

medium dose ICS & montelukast or LABA

For ages 0-4 what is step 5 asthma treatment

high dose ICS & montelukast or LABA

For ages 0-4 what is step 6 asthma treatment

High dose ICS & montelukast/LABA & oral steroids

when would you consider stepping down asthma meds

when asthma has been controlled for at least 3 months

what is the treatment for age 5-11 step 1

SABA PRN

what is the treatment for age 5-11 step 2

Low dose ICS alternate: LTRA or theophylline

what is the treatment for age 5-11 step 3

med dose ICS or low dose ICS+LABA or LTRA or theophylline

what is the treatment for age 5-11 step 4

med dose ICS+LABA alternate med dose ICS+LTRA or theo

what is the treatment for age 5-11 step 5

high dose ICS+LABA alternate high dose ICS+LTRA or theo

what is the treatment for age 5-11 step 6

high dose ICS+LABA+ oral steroid alternate High dose ICS+LTRA/theo+oral steroid