Flashcards in Asthma Deck (17)
-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
-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.
Common allergens/irritants/triggers leading to asthma exacerbation
-VOCs (volatile organic cmpd)
-chronic sinus dz
What is samter triad?
-aspirin/NSAID sensitivity, allergic rhinitis w/ nasal polyps, asthma
aka: aspirin sensitive asthma
Presentation of pt with Aspirin Sensitive asthma?
-malaise, rhinorrhea, bronchospasm, productive cough, ocassionally angioedema with in 20-30min of Aspirin or NSAID ingestion.
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
-clear trigger: exercise, cold air, alleren
-Allergic child (atopic dermatitis, allergic rhinitis)
-FHx: especially maternal
-Clear lung sounds
--allergic shiners, late stages clubbing
-wheezing; inspiratory and expiratory
-Spirometry* (confirms variable expiratory airflow limitation)
-responds to bronchodilator challenge (reversibility FEV1 greater than or equal to 12% and 200mL)
Look at Asthma classification charts.
Look at Medication algorithm.
What are the short acting/rescue meds for asthma?
-albuterol, xopenex, maxair
-short acting anticholinergic = ipatropium bromide
What are recommended ICS for:
12- Advair (fluticasone/salmeterol MDI)
4- Flovent (Fluticasone, MDI)
1- Pulmicort (Budesonide)
med: Singulair (Montelukast)
MOA: inhibits inflammation by blocking leukotriene cells.
-Asthma action plan
--red yellow green, medications, when to use
-F/U every 3-6mo
-Step down therapy*
who qualifies for Dry Powder inhaler? (DPI)
those who can correctly perform PFTs. (7-8yo)
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
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.
ED management of Asthma exacerbation
-3 back to back neb tx w/ albuterol and atrovent (ipatropium bromide)
if showing improvement...D/C.
If not improving Admit to hospital.
Inpatient care of Asthma
-continue nebs (SABA)
-continue oral corticosteroids
-re-evaluate on PAS scale.
Last resort efforts:
-sub Q terbutaline
-sub Q epi