Asthma

Question 1

how does a pulmonary insult impact a child with asthma?

Answer 1

it makes asthma significantly worse (exacerbation occurs)

Question 2

is wheezing always present in an asthmatic pt?

Answer 2

no

Question 3

If a patient responds to these two types of drugs, they probably have asthma

Answer 3

oral steroids and bronchodilators

Question 4

what two things is asthma often associated with?

Answer 4

allergies and family history

Question 5

what is a good way to help improve someone’s asthma if they have allergies?

Answer 5

remove the allergy triggers as much as possible

Question 6

according to Hadley, below what % O2 sat (for asthma) is when we would start worrying about hospital admittance

Answer 6

92%

Question 7

Coughing at what time of day is indicative of asthma

Answer 7

at night

Question 8

for a patient with persistent asthma, what type of med will they always be on?

Answer 8

ICS

Question 9

what time in life does asthma develop?

Answer 9

it always develops in childhood, unless some occupational cause

Question 10

what % of children with asthma have allergies?

Answer 10

80%

Question 11

about how many American children and adults have asthma?

Answer 11

6. 2 million kids

18. 4 million adults

Question 12

what age of people are most likely to have more ED visits and end up admitted because of asthma?

Answer 12

0-4 years old

Question 13

death by asthma increases with _______

Answer 13

age

Question 14

does severity of asthma predict death?

Answer 14

NO

Question 15

with more adherent use of _______ medications, asthmatic patient’s risk of death goes down

Answer 15

ICS

Question 16

what is the definition of asthma?

Answer 16

a CHRONIC lung disease characterized by REVERSIBLE BRONCHOCONSTRICTION and INFLAMMATION of the airways

Question 17

what happens to the airway lumen after an allergen challenge?

Answer 17

lumen rapidly narrows (bronchoconstriction)

Question 18

what are signs and symptoms of asthma?

Answer 18

cough(esp nighttime), wheeze (sometimes), SOB, chest tightness

Question 19

what three things do you use to diagnose asthma? What two things do you not use?

Answer 19

History, PE, and spirometry ( 4 yrs and older)

-don’t use: PFM (good for monitoring not diagnosing) or CXR

Question 20

what are 4 goals for asthma care by EPR-3?

Answer 20

1) . look for triggers
2) . written action plan
3) . planned care
4) . educate the patient

Question 21

what are 4 things you might see on an asthmatic patient’s PE?

Answer 21

1) . respiratory distress (maybe)
2) . wheezing (maybe)
3) . prolonged expiratory phase
4) . maybe allergies

Question 22

compare mild versus worse wheezing on a PE

Answer 22

mild- will see a late expiratory phase

worse- earlier wheeze on expiration than mild and maybe hear one during the inspiratory phase

Question 23

hearing a wheeze upon inspiration is a sign of what?

Answer 23

obstruction

Question 24

what is the best test done for asthma?

Answer 24

spirometry

Question 25

adults (greater than 12 yrs old) with intermittent asthma have how many symptoms, nighttime awakenings, SABA uses, & inference with normal activity? describe lung function

Answer 25

``` symptoms- less than 2 days/week nighttime- less than 2 per month SABA use- less than 2 days per week no interference with normal activity lung function- normal FEV1, normal FEV1/FVC ratio ```

Question 26

persistent asthma is divided into what three classifications?

Answer 26

mild, moderate, and severe

Question 27

mild adults asthmatics have how many symptoms, nighttime awakenings, SABA uses, & inference with normal activity? describe lung function

Answer 27

symptoms- greater than 2 days per week but not daily nighttime- 3-4/month SABA use- more than 2 days/week but not daily (not more than once a day) minor limitation with daily activity lung function: FEV1 < 80%, FEV1/FVC normal

Question 28

moderate adults asthmatics have how many symptoms, nighttime awakenings, SABA uses, & inference with normal activity? describe lung function

Answer 28

``` symptoms- daily nighttime- >1x/week but not nightly SABA use- daily some limitation with daily activity lung function: FEV1 >60% and < 80%, FEV1/FVC reduced 5% ```

Question 29

severe adults asthmatics have how many symptoms, nighttime awakenings, SABA uses, & inference with normal activity? describe lung function

Answer 29

``` symptoms- throughout the day nighttime- often 7x per week SABA use- several times per day extremely limited with daily activity lung function: FEV1 <60%, FEV1/FVC reduced >5% ```

Question 30

what is the difference between intermittent and persistent asthma?

Answer 30

intermittent asthma has been going on for less than a year, whereas persistent is greater than 2 years

Question 31

what is the baseline tx for intermittent asthma?

Answer 31

SABA (2 puffs every 4-6 hrs PRN, based on symptoms)

Question 32

what is highly important in inhaler use?

Answer 32

technique of use

Question 33

SABA inhaler is also known as ____________

Answer 33

a rescue inhaler

Question 34

what is the cheapest SABA and less side effects

Answer 34

levalbuterol (left sided isomer)

Question 35

what else besides SABAs can be used for a rescue asthma situation?

Answer 35

ICS or oral steroids

Question 36

what is the drug of choice for treating persistent asthma?

Answer 36

ICS- most potent and consistently effective

Question 37

what are 5 benefits of ICS?

Answer 37

reduce symptom severity, improve asthma control, improve lung function, reduce airway hyperresponsiveness, prevent exacerbations

Question 38

what statistic is reduced the more patients refill their low dose ICS canisters per year?

Answer 38

death in these patients decrease with more low dose ICS use

Question 39

what type of long term asthma med must be used in combo with ICS?

Answer 39

LABAs

Question 40

what is the purpose of using ICS/LABA drugs together?

Answer 40

to help maintenance of long term asthma (twice daily) but NOT indicated for relief of acute bronchospasm

Question 41

what type of asthma drugs are given to poorly controlled patients & are a way to avoid chronic oral steroids?

Answer 41

biologics (umab's)- also considered "last ditch" med for allergic pathway

Question 42

when a patient is using a nebulizer every day, what is that a sign of?

Answer 42

poorly controlled asthma because they need a higher dose to overcome symptoms rather than a better lower dose regimen

Question 43

explain tx of asthma for step 2-6 (persistent asthma)

Answer 43

2: low dose ICS 3: low dose ICS + LABA or medium dose ICS 4: medium dose ICS + LABA 5: High dose ICS + LABA + consider umab for allergy pt 6: high dose ICS + LABA + OCS + consider umab for allergy pt

Question 44

what is important to remember in the tx of asthma?

Answer 44

you want to keep assessing control and step up or down treatments as needed

Question 45

when is the only case to use LABA's alone?

Answer 45

pretreating for long distance exercise

Question 46

when is it ok to use SABAs more than 2x/week

Answer 46

when pretreating for exercise

Question 47

what are 4 important steps in tx asthma exacerbations in urgent care/ED?

Answer 47

1) . O2 & pulse ox 2) . SABA w ipratropium by nebulizer 3) . systemic steroids 4-5 days (oral or IV) 4) . upon discharge- follow up with provider and oral steroids for 5-10 days

Question 48

what is hadleys rule of thumb about asthmatic children who come to the drs?

Answer 48

if they are sick enough to come in, they should probably have steroids

Question 49

when patients with moderate persistent asthma evaluate their control, what % predict it is well controlled?

Answer 49

61% (not true- pts bad at eval)

Question 50

when patients with severe persistent asthma evaluate their control, what % predict it is well controlled?

Answer 50

32% (not true- pts bad at eval)

Question 51

what is the rule of twos mean?

Answer 51

``` it signifies poorly controlled asthma daytime symptoms- >2 days/week nighttime symptoms- >2 days/month Rescue SABA canister- >2/year Rescue SABA use- >2x/week ```

Question 52

what are the three zones of the asthma action plan?

Answer 52

based on peak flow meter values Green: >80% Yellow: 50-80% Red: <50%