asthma Flashcards
(51 cards)
1
Q
obstructive lung disease
A
- trouble blowing air out
- no change in volume of lungs
- asthma and COPD
2
Q
restrictive lung disease
A
- difficulty getting air into lungs
- decreased volume of air the lungs can hold
- no change in air flow
3
Q
asthma
A
- hypersens rxn -> inflammation and bronchoconstriction
- most persistent chronic childhood disorder
- obstruction is reversible
- in atopic pts
4
Q
characteristic sx of asthma
A
- cough esp at night or early AM
- wheezing
- breathlessness
- chest tightness
5
Q
mainstay of asthma tx
A
- ICS
6
Q
immune response in asthma
A
- IgE -> T and B cells activated -> mast cell degranulation -> histamine, leukotriene, and cytokine release
7
Q
early phase response in asthma
A
- bronchospasm
- edema
- airflow obstruction
8
Q
late phase response in asthma
A
- airway inflammation
- airflow obstruction
- airway hyperresponsiveness
9
Q
allergens
A
- IgE reactions
- pollen
- animal dander
- dust mites
- mold
- cockroaches
10
Q
inhaled irritants
A
- ACh -> bronchoconstriction
- perfumes
- tobacco smoke
- cleaning agents
- airborne chemicals
- wood burning stoves
11
Q
counseling for animal dander
A
- keep animals out of bedrom
- seal/ filter air ducts to bedroom
- HEPA filters
12
Q
counseling for dust mites
A
- keep humidity < 50%
- remove carpets
- wash bedding weekly in hot water
- encase mattress, pillow, and box springs in allergen covers
13
Q
counseling for cockroaches
A
- use poison bate or traps
- dont leave food or trash exposed
14
Q
counseling for pollen and outdoor molds
A
- use AC
- stay indoors when pollen count is high
15
Q
counseling for indoor molds
A
- fix all water leaks
- clean moldy surfaces
- reduce humidity < 50%
16
Q
asthma triggers/ exacerbating factors
A
- GERD
- obesity
- rhinitis
- occupational triggers
- viral respiratory infections
- exercise
- ASA/ NSAIDs
- strong emotions
- menstrual cycles
- sulfite sensitivity
- BB- including eye drops
17
Q
main domains when determining severity of asthma
A
- impairment
- risk
18
Q
asthma impairment domain
A
- frequency and intensity of sx
- fn limitations
- effect of QOL
19
Q
asthma risk domain
A
- future exacerbations
- loss of pulmonary function
- risk of ADRs from meds
20
Q
asthma treatment goals to reduce impairment
A
- prevent asthma sx
- infrequent use of SABA - < 2 days/week
- maintain near normal pulm fn and ADLs
- meet pts expectations
21
Q
asthma treatment goals to reduce risk
A
- prevent recurrent exacerbations
- prevent loss of lung fn
- provide optimal pharmacotherapy
22
Q
asthma action plan
A
- use peak flow meter to det how well lungs expel air
- can help pt ID loss of control, triggers, when to seek emergency care
- set up zones based on personal best
- estab personal best
- once personal best estab use every morning before meds
23
Q
green zone
A
- 80-100% of pts personal best
- cont activities and maintain meds
24
Q
yellow zone
A
- 50-80% of pts personal best
- contact provider
- may need med adjustment
25
red zone
- < 50% of pts personal best
| - emergency
26
establishing a personal best
- use peak flow meter
- take 3 readings daily
- estab over 2-3 weeks
- best= HIGHEST reading
27
follow up care for asthma
- every 2-6 weeks while gaining control
- every 1-6 months once controlled
- at 3 mo intervals if reduction in therapy is anticipated
28
what must you assess at every asthma visit
- asthma control and med adherence
- med technique
- asthma action plan
- pt concerns
29
asthma control test
- used to assess risk domain
| - score of < 19 means asthma is not under conrol
30
how many steps should you increase if asthma is not well controlled
- one step up
31
how many steps should you increase if asthma is very poorly controlled
- step up by 1-2 steps
| - consider short course PO steroids
32
asthma risk factors for death
- prior severe exacerbations= intubation or ICU admission
- 2+ hospitalizations or 3+ ED visits/ year
- > 2 canisters of SABA per month
33
stepping down asthma therapy
- must be well controlled for at least 3 mo
- gradual decrease 25-50%
- closely follow up in 2-6 weeks
- consider hx of exacerbations
- use LEAST amount of med needed for control
34
rescue regimens for asthma
- SABA- albuterol
35
maintenance regimen for asthma
- ICS
- LABA- always in combo with ICS
- LAMA- always in combo with ICS
- leukotriene antag
- theophylline
36
therapeutic considerations for asthma tx
- cost and coverage
- ability to use device
- product avail
- adverse effects
- pt population, lifestyle, preference
37
MDI advantages
- < 1 min
- small/ portable
- no drug prep
- mechanical ventillation
38
MDI disadvantages
- technique/ timing is essential
- freon effect
- requires breath hold
- oropharyngeal deposition
39
MDI steps for use
- hold in L position
- exhale completely
- put lips on mouth piece and breath in deeply and slowly while depress canister
- remove from mouth and hold breath 10 sec
40
what type of inhalers are HFA
- MDI
41
DPI advantages
- < 1 min
- less technique/ timing
- small/ portable
- usually cost less than MDI
42
DPI disadvantages
- some dose prep
- requires breath hold and fast inhalation
- oropharyngeal deposition
- no mechanical ventilation
43
what type of inhalers are respiclicks
- DPI
44
nebulizer advantages
- minimal technique/ timing
- no breath hold
- mechanical ventilation
45
nebulizer disadvantages
- more expensive
- drug prep required
- admin time 5-15 min
- bulky, less portable, requires power source
- must clean regularly
46
step 1 asthma tx
- SABA
| - for intermittent asthma only
47
step 2 asthma tx
- low dose ICS
| - alternatives: mast cell stabilizer, LTRA, theophylline
48
step 3 asthma tx
- low dose ICS + LABA
OR
- mod dose ICS alone
- alt- replace LABA with LTRA or theophylline
49
step 4 asthma tx
- mod dose ICS + LABA
| - alt- replace LABA with LTRA or theophylline
50
step 5 asthma tx
- high dose ICS + LABA
| - also consider xolair for pts who have allergies
51
step 6 asthma tx
- high dose ICS + LABA + PO steroid
| - also consider xolair for pts who have allergies
