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foundations pulm exam > asthma > Flashcards

asthma Flashcards

1
Q

define asthma

A 
chronic disorder
variable and recurring symptoms
airflow obstruction
bronchial hyperresponsiveness
underlying inflammation
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2
Q

what are examples of airway hyper-responsiveness?

A 
particulate inhalants/allergens
temperature changes
stress
reflux
exercise
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3
Q

what are examples of inflammation?

A

inflammatory cell infiltration with eosinophils, neutrophils and T lymphocytes
hyperplasia of goblet cells
mast cell activation

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4
Q

what are examples of airflow obstruction?

A

smooth muscle hypertrophy
collagen deposition in basement membranes
edema of airways

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5
Q

what are examples of narrowed airway?

A

smooth muscle constriction and hyperplasia

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6
Q

what are the main two receptors in asthma?

A

beta-2 receptors and muscarinic receptors for smooth muscle relaxation

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7
Q

what are the classic symptoms of asthma?

A

wheezing, cough, and dyspnea

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8
Q

how do you diagnose asthma?

A

hx of respiratory symptoms AND demonstration of variable, reversible, expiratory airflow obstruction as well has H&P AND spirometry

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9
Q

what in the pt’s hx could lead to increased risk for asthma?

A

atopy, obesity, allergies, smoking, atopy in family hx, respiratory disease

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10
Q

what might you see in the ROS for asthma?

A

general: fever, chills, night sweats, weight loss
skin: eczema, rashes, pruritis
HEENT: itchy eyes, nasal congestion, sneezing
Pulm: wheezing, cough, dyspnea
Cardiac: chest pain, palpitations, edema, orthopnea

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11
Q

what is the atopic triad?

A

allergy, asthma, and eczema

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12
Q

what are non-exacerbation pt clues?

A 
allergic rhinitis
nasal polyps
eczema
normal lung exam
possible tachycardia
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13
Q

what is the gold standard for diagnosing asthma?

A

spirometry

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14
Q

what are normal FEV1 and FVC values?

A

80% or greater

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15
Q

what FEV1/FVC ratio indicates obstructive disease?

A

less than 70%

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16
Q

FEV1 tells us how ______ the obstruction is

A

severe

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17
Q

how to classify the obstructions?

A

over 70 = mild
50-69 = moderate
under 50 = severe

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18
Q

in spirometry, we look at _______

A

reversibility

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19
Q

FEV1 needs to increase by how much to indicate a positive response?

A

12% or more

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20
Q

in a bronchoprovocation test, what does the pt inhale to determine if he/she has a hyperresponsive response?

A

metacholine

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21
Q

what are the four categories of symptoms that therapy is based on?

A
  1. symptom frequency
  2. nighttime awakenings
  3. need for SABA inhaler
  4. interference with normal activity

choose the most severe symptom

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22
Q

intermittent asthma is classified how?

A

having symptom frequency 2 days or less per week
having nighttime awakenings 2 or less times per month
SABA use 2 days or less per week
no interference with normal activity
0-1 systemic steroid use per year

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23
Q

mild persistent asthma is classified how?

A 
symptom frequency >2 days/week
nighttime awakenings 3-4x/month
SABA use > 2 days/week
minor limitation with normal activity
2 or more systemic steroid use per year
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24
Q

moderate persistent asthma is classified how?

A 
symptom frequency daily
nighttime awakenings more than once per week but not nightly
SABA use daily
some limitation with normal activity
2 or more systemic steroid use per year
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25
severe persistent asthma is classified how?
``` symptom frequency throughout the day nighttime awakenings often 7x/week SABA use several times per day extremely limited with normal activity 2 or more systemic steroid use per year ```
26
what are the four essential components in managing asthma?
1. routine monitoring of symptoms and lung function 2. patient education 3. environmental factors (trigger factors) and comorbid conditions that contribute to asthma severity 4. pharmacologic therapy
27
the first goal of reducing impairment in asthma is?
keeping the symptoms under 2 times per week or month
28
what are possible medications that can trigger asthma?
ASA and NSAIDS
29
what are dietary sulfides to avoid?
``` beer wine processed potatoes dried fruit sauerkraut shrimp ```
30
in airflow obstruction, smooth muscle constriction could lead to?
bronchospasm
31
what does a B-2 agonist do?
bronchodilator - relieves bronchospasm by relaxing bronchial smooth muscle
32
what are the two types of B-2 agonists?
SABA and LABA
33
which B-2 agonist can you use in exercise induced asthma?
SABA
34
what are examples of SABAs?
albuterol pirbuterol levalbuterol (use this if pt has tachycardia or palpitations with albuterol)
35
LABAs are NOT for ________
emergencies
36
what are examples of LABAs?
formoterol salmeterol arformoterol
37
what is the black box warning for LABA
increase the risk fo asthma death when used alone without concurrent inhaled steroid (increased risk in black population)
38
inhaled corticosteroids are used in conjunction with LABAs, what are examples of inhaled corticosteroids?
beclamethasone fluticasone triamcinolone
39
what are examples of LABA and ICS combination inhalers?
salmeterol + fluticasone formoterol + budesonide formoterol + mometasone
40
leukotriene receptor antagonist (LTRA) is not a first line asthma/allergy medication, what are examples?
montelukast (singulair) | zafirlukast
41
what med class is only used for acute exacerbations?
``` anticholinergics examples: ipratropium tiotropium *can be combined with SABA ```
42
if someone has very severe asthma, what medication would you use?
monoclonal antibody examples: omalizumab reslizumab and mepolizumab (use in eosinophilia)
43
when are oral corticosteroids used?
acute exacerbations or severe chronic symptoms | examples: prednisone or methylprednisolone
44
what meds are used for mucus production?
anticholinergics
45
what meds are used for bronchospasm?
SABA and LABA
46
what meds are used for mucosal edema (inflammation)?
inhaled corticosteroids LTRA 5-lipoxygenase inhibitor, mast-cell stabilizers, monoclonal antibody
47
what med do you give if intermittent asthma?
SABA PRN
48
how do you treat persistent asthma with medications?
up the dose of the ICS (low, medium, high) + LABA
49
if high dose ICS and LABA are not working, what do you add?
oral systemic glucocorticoids | also be considering omalizumab in pts with allergies
50
what is the peak flow expiratory rate (PEFR)
helps pt determine need for rescue inhaler | predicted average PEFR based on age/height
51
PEFR has a color scale of green, yellow, and red, what does each color mean?
``` green = good to go yellow = caution, use SABA red = go to ER ```
52
what medication should you consider adding to a SABA for severe exacerbations?
ipratropium
53
if no immediate and marked response to the SABA, what should you start?
IV steroids
54
when should you consider admitting pts to the ICU if not responding to treatment?
4-6 hours
55
what are S&S of acute exacerbations?
``` inability to speak full sentences accessory muscle use tri-pod positioning inability to lie supine SpO2 < 90% PCO2 elevated ```
56
what are imminent respiratory arrest signs?
confusion cyanosis fatigue agitation
57
how to treat mild-moderate exacerbations in hospital?
titrate O2 until SpO2 > 90% albuterol + anticholinergic IV or oral glucocorticosteroids (4-6 hr to work)
58
what are adjunct therapies for severe exacerbation?
``` IV magnesium IV epinephrine terbutaline heliox ketamine neuromuscular blockers ```
59
if pt does well with 2-3 treatments of SABA (20 minutes apart) at the office, what is the next step?
continue SABA q3-4h for the next 24-48 hours | can consider short course of oral systemic corticosteroids
60
if pt has incomplete response to the 2-3 treatments of SABA, what is the next step?
add oral systemic corticosteroid continue SABA contact clinician
61
if pt has no response to the 2-3 treatments of SABA, what is the next step?
call your doctor and proceed to the ED
62
define status asthmaticus
acute exacerbation of asthma unresponsive to initial treatment with bronchodilators symptoms of dyspnea, CO2 retention, hypoxemia and respiratory failure
63
what are preventative measures for asthma?
pneumococcal vaccination | annual influenza vaccination

foundations pulm exam (10 decks)

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