or = 2 days per week daytime symptoms 80%

Asthma Flashcards by Charles Cabus

Major risk factor for asthma. (Harrison’s 19th edition, pp 1669)

Atopy

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Spirometry findings in asthma. (Harrison’s 19th edition, pp 1675)

Confirms airflow limitation

Reduced FEV1, FEV1/FVC ratio and PEF

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Reversibility in spirometry. (Harrison’s 19th edition, pp 1675)

> 12% and 200mL increase in FEV1 15 mins after an inhaled SABA
OR
2-4 week trial of OCS (prednisone or prednisolone 30-40mg daily)

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Confirms the diurnal variations in airflow obstruction in asthma. (Harrison’s 19th edition, pp 1675)

Measurements of PEF twice daily

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Parameters/components use in assessing severity and control of asthma. (Harrison’s 19th edition, pp 1679).

Daytime symptoms
Limitation of activities
Nocturnal symptoms or awakening
Need for reliever or rescue treatment
Lung function (PEF or FEV1)

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Controlled asthma. (Harrison’s 19th edition, pp 1679)

No (< or = 2/week) daytime symptoms
No limitation of activities 
No nocturnal symptoms or awakening
No (< or = 2/week) Need for reliever or rescue treatment
Normal lung function (PEF or FEV1)

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Partly controlled asthma. (Harrison’s 19th edition, pp 1679)

> 2/week daytime symptoms
Any limitation of activities
Any nocturnal symptoms or awakening
2/week need for reliever or rescue treatment
< 80% predicted or personal best lung function (PEF or FEV1)

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Uncontrolled asthma. (Harrison’s 19th edition, pp 1679)

Three or more features of partly controlled

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Intermittent asthma.

< or = 2 days per week daytime symptoms
< or = 2 times per month nocturnal symptoms or awakening
< or = 2 days per week need for reliever or rescue treatment
No limitation of activities
Normal FEV1 between exacerbations; FEV1 > 80%

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Mild persistent asthma.

> 2 days per week daytime symptoms
3-4 times per month nocturnal symptoms or awakening
2 days per week need for reliever or rescue treatment
Minor limitation of activities
FEV1 >/= 80% of predicted; FEV1/FVC normal

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Moderate persistent asthma.

daily daytime symptoms
once per week nocturnal symptoms or awakening
daily need for reliever or rescue treatment
some limitation of activities
80%> FEV1 > 60% of predicted; FEV1/FVC reduced to 5%

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Severe persistent asthma.

Throughout the day symptoms
Often 7 times per week nocturnal symptoms or awakening
Several times per day need for reliever or rescue treatment
Extremely limited activities
FEV1 < 60% of predicted; FEV1/FVC reduced to > 5%

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Treatment for mild intermittent asthma. (Harrison’s 19th edition, pp 1679)

Short acting B2-agonist, as needed

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Treatment for mild persistent asthma. (Harrison’s 19th edition, pp 1679)

Short acting B2-agonist, as needed

+ low dose ICS

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Treatment for moderate persistent asthma. (Harrison’s 19th edition, pp 1679)

Short acting B2-agonist, as needed
+ low dose ICS
+ long acting B2-agonist

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Treatment for severe persistent asthma. (Harrison’s 19th edition, pp 1679)

Short acting B2-agonist, as needed
+ High dose ICS
+ long acting B2-agonist

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Treatment for very severe persistent asthma. (Harrison’s 19th edition, pp 1679)

Short acting B2-agonist, as needed
+ High dose ICS
+ long acting B2-agonist
+ OCS

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Most common reason for poor control of asthma. (Harrison’s 19th edition, pp 1679)

Noncompliance to medication, particularly ICS

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Most effective controllers of asthma. (Harrison’s 19th edition, pp 1677)

Inhaled corticosteroids

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The characteristic structural changes of airway remodeling in asthma. (Harrison’s 19th edition, pp 1675)

Increased airway smooth muscle
Fibrosis
Angiogenesis
Mucus hyperplasia

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The characteristic physiologic abnormality of asthma. (Harrison’s 19th edition, pp 1675)

Airway hyperresponsiveness

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The pathologic changes in asthma are found in?. (Harrison’s 19th edition, pp 1672)

In all airways

do not extend to the lung parenchyma

Pathology in asthma. (Harrison’s 19th edition, pp 1671-1672)

Activation on eosinophils, T-lymphocytes and mast cells
Thickening of the basement membrane due to subepithelial collagen deposition
Shed/friable epithelium with reduced attachments to airway walls and increase number in lumen
Thickened and edematous airway
occlusion of the airway lumen by mucus plug
Vasodilation and angiogenesis

Describes as the excessive bronchoconstrictor response to multiple inhaled triggers that would have no effect on normal airways. (Harrison’s 19th edition, pp 1675)

Airway hyperresponsiveness

The degree of inflammation is _____ related to disease severity of asthma. (Harrison’s 19th edition, pp 1671)

Poorly

In asthma, the inflammation in the respiratory mucosa is from the _____ to ______, but with predominance in the ________. (Harrison’s 19th edition, pp 1672)

Trachea, terminal bronchioles, bronchi

Clinical features of severe asthma. (Harrison’s 19th edition, pp 1679)

Increasing chest tightness, wheezing, and dyspnea that are often not or poorly relieved by their usual reliever inhaler

It maybe present in acute severe asthma but this is rarely a useful clinical sign. (Harrison’s 19th edition, pp 1679)

Pulsus paradoxus

Additional clinical features in severe exacerbation. (Harrison’s 19th edition, pp 1679)

Unable to complete sentences and cyanotic. | chest tightness, wheezing and dyspnea

These should never be given or not be used routinely in acute severe asthma. (Harrison’s 19th edition, pp 1679)

Antibiotics (unless there are signs of pneumonia) | Sedatives (may depress ventilation)

Mainstay of treatment in acute severe asthma. (Harrison’s 19th edition, pp 1679)

High doses of SABA

This has been shown to be effective when added to B2-agonists for treatment of acute severe asthma. (Harrison’s 19th edition, pp 1679)

Magnesium sulfate

Maybe effective in patients with acute severe asthma that who are refractory to inhaled therapies. (Harrison’s 19th edition, pp 1679)

Slow infusion of aminophylline

This may be indicated for patients with impending respiratory failure. (Harrison’s 19th edition, pp 1679)

Prophylactic intubation

Intubated patients due to respiratory failure may benefit from this drug if they have not responded to conventional bronchodilator. (Harrison’s 19th edition, pp 1679)

Halothane

Bronchodilator effect of theophylline. (Harrison’s 19th edition, pp 1677)

Due to inhibition of phosphodiesterases in airway smooth-muscle cells which increases cyclic cAMP

Mechanism of action of Anticholinergics (Ipatropium and tiotropium). (Harrison’s 19th edition, pp 1676)

Prevent cholinergic nerve-induced bronchoconstriction and increases mucus secretion

Used intravenously for the treatment of acute severe asthma. (Harrison’s 19th edition, pp 1679)

Corticosteroids

Mechanism of action of Beta-2agonist on airways. (Harrison’s 19th edition, pp 1676)

Relax airway smooth-muscle

Non bronchodilator effects of Beta-2 agonists. (Harrison’s 19th edition, pp 1676)

Inhibition of mast cell mediator release Reduction in plasma exudation Inhibition of sensory nerve activation

Anti-inflammatory effect of Beta-2 agonists. (Harrison’s 19th edition, pp 1676)

No effects on inflammatory cells | No reduction in airway hyperresponsiveness

Mechanism of action of Beta-2agonist on airways. (Harrison’s 19th edition, pp 1676)

Relax airway smooth-muscle

Non bronchodilator effects of Beta-2 agonists. (Harrison’s 19th edition, pp 1676)

Inhibition of mast cell mediator release Reduction in plasma exudation Inhibition of sensory nerve activation

Anti-inflammatory effect of Beta-2 agonists. (Harrison’s 19th edition, pp 1676)

No effects on inflammatory cells | No reduction in airway hyperresponsiveness

Short-acting B2-agonists. (Harrison’s 19th edition, pp 1676)

Albuterol | Terbutaline

Long-acting B2-agonists. (Harrison’s 19th edition, pp 1676)

Salmeterol | Formeterol

Most common side effect of Anticholinergics. (Harrison’s 19th edition, pp 1677)

Dry mouth

Most common side effects of B2-agonists. (Harrison’s 19th edition, pp 1676)

Muscle tremor | Palpitations

Approximately how many of asthmatic patients who are pregnant improve during the course of pregnancy? (Harrison’s 19th edition, pp 1680)

1/3 | 1/3 deteriorate, 1/3 unchanged

Drugs that are safe to use for asthmatic patients who are pregnant. (Harrison’s 19th edition, pp 1680)

SABA ICS Theophylline Prednisone

Rationale on using prednisone over of prednisolone for asthmatic patients who are pregnant. (Harrison’s 19th edition, pp 1680)

Prednisone cannot be converted to active prednisolone by fetal liver, thus protecting the fetus from systemic effects.

Drugs that are safe to use for asthmatic patients who are breast-feeding. (Harrison’s 19th edition, pp 1680)

SABA ICS Theophylline Prednisone

In acute severe asthma, this should be given by face mask to achieve oxygen saturation of > 90%. (Harrison’s 19th edition, pp 1680)

High concentration of oxygen