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Flashcards in Asthma Deck (60):
1

What is the definition of asthma?

Chronic inflammatory lung disease that is associated with cough, dyspnea, and wheezing

2

What are the three characteristics of asthma? Which has to be found for a diagnosis of asthma?

-symptoms of cough, dyspnea, and wheezing
-Reversible airway narrowing
-**Increased airway responsiveness to stimuli**

3

What is the most common chronic childhood disorder in first world countries? What generally happens as these children age?

Asthma
If resolves after adolescence, then does not usually come back

4

What is the trend of hospitalization and mortality rates secondary to asthma?

Increasing

5

What ethnicity is more likely to die from asthma?

Blacks

6

What are the risk factors for developing asthma? (4)

-Atopy
-Indoor allergen exposure
-Rhinitis
-Occupational exposures

7

What is atopy?

IgE mediated predisposition to developing allergic reactions

8

What are the four common indoor allergens that can cause asthma?

-House dust mites
-animal proteins
-cockroach antigen
-alternaria mold

9

Early or late menarche is a risk factor for asthma?

Early

10

What is the association between smoking and asthma?

Smoking exposure, including prenatally, predisposed to asthma

11

What is the associated between weight and asthma?

Obesity predisposes to asthma

12

What is the relation between maternal age and asthma?

Increasing maternal age increases asthma incidence

13

What is the primary pathological finding associated with asthma?

airway obstruction d/t combination of inflammation and cellular infiltration

14

True or false: respiratory infections may predispose to asthma

True

15

True or false: the degree of inflammation of the airways poorly correlates to the degree of asthma

False--correlates well

16

What are the three identifiable histological findings with asthma?

-Infiltration of the airway with eosinophils
-Upregulated proinflammatory cells
-Alterations in the non-cellular components of the airway wall

17

What causes the infiltration of eosinophils in the airways of asthmatics?

Mast cell antigen release

18

What cause the reduced response to medication in asthmatics?

Bronchial wall remodeling

19

What are the four major inflammatory mediators of asthma?

-Histamine
-Leukotrienes
-Kallikrein
-Platelet activating factor

20

What are the four components of asthma airway obstruction?

-Inflammation
-Smooth muscles contraction/hypertrophy
-Mucus gland hypersecretion
-Airway remodeling

21

What are the three major drugs that are asthma triggers?

ASA
NSAIDs
Beta blockers

22

What causes cold air asthma?

Acute cooling of the airway triggers irritant receptors

23

What are the three cardinal symptoms of asthma?

Cough
Wheezing
Dyspnea

24

When is dyspnea especially prominent with asthma?

After exertion or at night

25

When is cough especially prominent with asthma?

-after exertion
-Breathing cold air
-at night

26

What causes the exacerbation at night of asthma?

-Lower levels of endogenous circulating corticosteroids
-Increases in histamine

27

Is the cough with asthma productive?

Not unless infected

28

Is wheezing diagnostic for asthma?

No

29

What happens to the intensity of the breath sounds with asthma?

Decreased

30

How do you diagnose asthma?

Clinical features
c/w obstructive

31

What are the three major tests to diagnose asthma?

-Bronchoprovocation
-Pre and post bronchodilator spirometry
-Serial peak flow measurements

32

What is the MOA of methacholine?

Stimulates M3 receptors in the bronchi, causing asthma

33

What happens to the peak flow rate with asthma?

Decreased

34

What are the major pitfalls of provocation testing? (2)

-False positive if recent URI
-False negative if on meds

35

Does bronchial hypersensitivity alone indicate the presence of asthma?

No--sensitive, but not specific finding

36

What are the three criteria to asses the severity of asthma?

-Days with ssx
-Nocturnal ssx
-Peak flow rates/variability

37

What patients can be treated with a PRN rapid acting beta agonists only? If this is not true, what must be added to the drug regimen?

Patients with intermittent ssx:
-less than 2 days/week
-less than 2 nocturnal awakening per month

If more than that, then need an anti-inflammatory

38

What are the goals of care with asthma therapy? (5)

-Freedom from frequent ssx
-minimal need for beta agonists
-Optimize lung fx
-Maintain normal daily activities
-Satisfaction with asthma care

39

Diurnal variation in peak flows of greater than what percent is considered diagnostic for asthma?

More than 20% on 3 or more days

40

When are anticholinergics used for treating asthma?

Refractory emergencies

41

Why are theophylline drugs not used much anymore?

Drug interactions
Narrow therapeutic range

42

What is the major antibody that can be used to treat asthma? MOA?

Omalizumab--anti IgE

43

What is the mainstay of treatment for long term asthma?

Inhaled corticosteroids

44

What is the indication for systemic corticosteroids? What must be done if these patients receive this therapy?

bad asthma, but need to taper

45

Is there any benefit of using a nebulizer vs an albuterol metered inhaler?

No

46

When are levo-beta agonists used?

Only if the pt has sensitivites

47

Why is it inappropriate to use monotherapy of a long acting beta agonist for asthma?

Risk for sudden cardiac death

48

What is the MOA of ipratropium?

Anticholinergic for asthma ("I pray I can breathe again")

49

When should an inhaled steroid be administered to patients with asthma? How should this be administered?

When they have greater than intermittent asthma

Should be used in a stepwise fashion

50

What are the side effects of inhaled corticosteroids? Are there systemic effects?

Oral thrush, but no systemic effects

51

When is systemic corticosteroids indicated for asthma? What corticosteroid is usually used?

Acute exacerbations
Prednisolone

52

When should anti-inflammatories be used with asthma treatment?

More than intermittent asthma (after step 1)

53

What is the treatment for emergent asthmatic episodes?

-Oxygen
-Neb every 20 minutes
-Ipratropium if severe

54

Why is hydration important for asthma treatment?

Reduce mucus thickness

55

What are the two leukotriene blockers used to treat asthma? Which leukotriene receptors do they block?

Zileuton
Zafirlukast

LTD4 receptors

56

What cells release leukotrienes in asthmatic patients?

Eosinophils

57

What happens to wheezing with progression of an acute asthma exacerbation?

Gets less loud

58

How bad is the asthma if there is accessory respiratory muscle use?

Moderate to severe

59

When does oxygen saturation fall with an asthma exacerbation?

moderate falls a little (low 90s)
Severe falls a lot (below 90%)

60

What happens to HR as asthma gets worse?

tachycardia to bradycardia when respiratory arrest is imminent