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Flashcards in Asthma Deck (17)
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1

Asthma Definition

-chronic inflammatory dz of the airways w/:
--airway obstruction that may or may not be reversible either spontaneously or with medication
--inflammation caused by cellular components
--increased airway hyper responsiveness
--airway remodeling

2

Pathophysiology Asthma

-inhale trigger leading to rapid bronchospasm
-mast cell degranulation and recruitment of histamine and leukotrienes (cellular components)
-late response (inflammatory cells) leading to chronic inflammation.

3

Common allergens/irritants/triggers leading to asthma exacerbation

Allergens:
-dust mites
-pet dander
-rodents
-mold

Irritants:
-smoke
-strong fumes
-chemicals
-VOCs (volatile organic cmpd)

Triggers:
-tobacco
-exercise
-GERD
-chronic sinus dz

4

What is samter triad?

-aspirin/NSAID sensitivity, allergic rhinitis w/ nasal polyps, asthma

aka: aspirin sensitive asthma

5

Presentation of pt with Aspirin Sensitive asthma?

-malaise, rhinorrhea, bronchospasm, productive cough, ocassionally angioedema with in 20-30min of Aspirin or NSAID ingestion.

6

Dx of asthma

-timeline; persistent cough
-cough worse at night, awakes pt at night
-cough that interferes with activities such as sports/recreational playing
-recurrent wheeze, SOB
-recurrent URI.
-clear trigger: exercise, cold air, alleren
-Allergic child (atopic dermatitis, allergic rhinitis)
-FHx: especially maternal
-Clear lung sounds

-PE:
--allergic shiners, late stages clubbing
--Tripod breathing
--tachypnea
-hypoxemia
-retractions
-wheezing; inspiratory and expiratory


-Spirometry* (confirms variable expiratory airflow limitation)
-responds to bronchodilator challenge (reversibility FEV1 greater than or equal to 12% and 200mL)

7

Look at Asthma classification charts.

Look at Medication algorithm.

Thanks. :)

8

What are the short acting/rescue meds for asthma?

SABA:
-albuterol, xopenex, maxair


other:
-short acting anticholinergic = ipatropium bromide

9

What are recommended ICS for:
-12+ YO
-4+ YO
-1+ YO

12- Advair (fluticasone/salmeterol MDI)

4- Flovent (Fluticasone, MDI)

1- Pulmicort (Budesonide)

10

Leukotriene Blockers
-med name
-MOA

med: Singulair (Montelukast)

MOA: inhibits inflammation by blocking leukotriene cells.

11

Asthma Management

-Asthma action plan
--red yellow green, medications, when to use
-peak flow
-F/U every 3-6mo
-EDUCATION!!!!!!!
-Step down therapy*

12

who qualifies for Dry Powder inhaler? (DPI)

those who can correctly perform PFTs. (7-8yo)

13

What is included in a asthma action plan?

AAP is a written plan of care from health care provider with guidelines for treating asthma sx

-includes medication information, usual triggers, special instructions

14

Green zone sx

Yellow zone sx

Red zone sx

Green: no asthma sx, 80% of personal best of peak flow

Yellow: coughing, wheezing, chest tightness, SOB, 50-80% best of peak flow

Red: Diff talking, walking, or drinking, nasal flaring when inhaling. yellow sx that is not relieved from medications. Lower than 50% of best peak flow.
*Call 911

15

ED management of Asthma exacerbation

-3 back to back neb tx w/ albuterol and atrovent (ipatropium bromide)

Oral steroids

if showing improvement...D/C.

If not improving Admit to hospital.

16

Inpatient care of Asthma

-continue nebs (SABA)
-continue oral corticosteroids
-re-evaluate on PAS scale.


Last resort efforts:
-sub Q terbutaline
-sub Q epi
-IV magnesium
-bipap

17

ICS aka?

controllers