Asthma

Question 1

What is the most common chronic dz in childhood?

Answer 1

Asthma

Question 2

Asthma sx’s

Answer 2

1. Wheezing (expiratory)
2. Cough (nocturnal)
3. Dyspnea
   * Non-specific

Question 3

Asthma Dx

Answer 3

1. Hx of respiratory sx’s AND
2. Demonstration of variable, reversible*, expiratory airflow obstruction
3. History + Physical AND spirometry

Question 4

What is one of the biggest risks factors for having asthma?

Answer 4

Atopy

• Genetic association
• Predisposition toward developing certain allergic hypersensitivity rxn
• -> i.e. atopic dermatitis

Question 5

Atopic triad

Answer 5

1. Allergy- Allergic rhinitis, nasal polyps (ASA allergy??)
2. Asthma
3. Eczema- Atopic dermatitis

Question 6

What is the gold standard diagnostic test?

Answer 6

Spirometry/PFTs

Question 7

What does FEV1 tell you?

Answer 7

Forced expiratory volume in 1 sec

Tells you the Severity of obstruction

Question 8

What is a normal FEV1 value?

Answer 8

> or equal to 80%

Question 9

What is a normal FVC value?

Answer 9

> or equal to 80%

Question 10

What FEV1/FVC ratio percentage indicates obstructive disease?

Answer 10

<70%

Question 11

What FEV1 value is considered mild obstruction?

Answer 11

> 70%

Question 12

What FEV1 value is considered moderate obstruction?

Answer 12

50-69&

Question 13

What FEV1 value is considered severe obstruction?

Answer 13

<50%

Question 14

What determines reversibility?

Answer 14

Bronchodilator (albuterol)

Question 15

What increase in FEV1 after given a bronchodilator is diagnostic of asthma?

Answer 15

12% or more

Question 16

What is a good test to perform if a patient has normal baseline flows, but you are suspicious of asthma? How does it work?

Answer 16

Bronchoprovocation testing

• Inhale methacholine or mannitol
• Trying to trigger/induce asthma exacerbation

Question 17

What is the Diagnostic Approach-Symptom categorization

Answer 17

1. Sx frequency
2. Nighttime awakening
3. Need fo short acting beta-agonist
4. Interference with normal activity

Question 18

What medications do you want to avoid in asthma?

Answer 18

1. ASA- Samter triad, nasal polyps

2. NSAIDs

Question 19

Beta-2 Agonist MOA

Answer 19

Bronchodilator

-Relieve bronchospasm by relaxing bronchial smooth muscle

Question 20

List short acting B-2 Agonists (SABA)

Answer 20

• Albuterol
• Pirbuterol
• Levalbuterol

Question 21

When would you use a SABA?

Answer 21

1. Emergently

2. Preventative- Exercise

Question 22

What do you use a long acting B-2 Agonists (LABA) for?

Answer 22

PREVENTION

Question 23

long acting B-2 Agonists (LABA) contraindications

Answer 23

1. Not for rescue during acute exacerbation

2. Not a PRN inhaler

Question 24

LABA black box warning

Answer 24

Long-acting B-agonists may increase the risk of asthma death when used alone= MUST USE WITH INHALED STEROID

Question 25

What do you use an inhaled corticosteroid for?

Answer 25

- Decrease inflammation | - Preventative therapy

Question 26

Benefit of a LABA and ICS combo inhaler

Answer 26

Long acting relief for: | Bronchospasm + Reduced inflammation

Question 27

Leukotriene Receptor Antagonist MOA

Answer 27

-Blocks LT receptors, mitigates inflammation and mucosal edema effects

Question 28

Leukotriene Receptor Antagonist example

Answer 28

Montelukast (Singulair)

Question 29

Leukotriene Receptor Antagonist indication

Answer 29

Asthma + Allergies

Question 30

Anticholinergics MOA

Answer 30

Decrease mucous secretions

Question 31

Anticholinergics indication

Answer 31

acute exacerbation

Question 32

Example of Anticholinergics

Answer 32

Ipratropium (Atrovent)

Question 33

Monoclonal Antibody indications

Answer 33

- Severe Asthma | - Use in pulmonology office

Question 34

Omalizumab (solaire) MOA

Answer 34

Recombinant antibody that binds IgE WITHOUT activating mast cell release

Question 35

Reslizumab (Cinqair) & Mepolizumab (Nucala)

Answer 35

IL-5 antagonist monoclonal antibodies

Question 36

Oral corticosteroid indications

Answer 36

1. Acute exacerbation | 2. Severe chronic sx's

Question 37

Methylxanthines/Phosphodiesterase (theophylline) inhibitors adverse reactions

Answer 37

Toxicity and adverse CV effects= avoid use!

Question 38

What is the predicted average Peak Expiratory Flor Rate (PEFR) based on?

Answer 38

1. Age | 2. Height

Question 39

After how long do you admit a pt to ICU for an acute asthma exacerbation?

Answer 39

4-6 hrs

Question 40

Signs and sx's of severe exacerbation

Answer 40

1. Inability to speak full sentences 2. Accessory muscle use 3. Tri-pod positioning 4. SpO2< 90%

Question 41

Imminent respiratory arrest sx's

Answer 41

1. Confusion 2. Cyanosis 3. Fatigue 4. Agitation

Question 42

Rx treatment mid-moderate acute exacerbation

Answer 42

1. O2 titrate up to SpO2>90% | 2. Albuterol +/- Antcholinergic (Ipratropium)

Question 43

Adjunct therapies severe acute exacerbation

Answer 43

1. IV magnesium 2. IV epinephrine 3. Terbutaline 4. Heliox 5. Ketamine 6. Neuromuscular blockers

Question 44

Preventive care

Answer 44

1. Pneumococcal vaccine prior to age 65 | 2. Annual influenza vaccine