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NURS 503 > Asthma and COPD > Flashcards

Asthma and COPD Flashcards

1
Q

What is asthma (pathophysiology)?

A

Chronic reversible inflammatory disorder of the airways

  • Increased responsiveness of tracheobronchial tree to stimuli → episode reversible narrowing and inflammation of airways
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2
Q

What are the clinical hallmarks of asthma?

A
  • Episodic wheezing
    • Breathlessness, anxiety
  • Dyspnea
  • Cough (most common symptom)
  • Sputum production
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3
Q

True/false: Asthma is commonly diagnosed before 12 months of age

A

False - rarely diagnosed before 12 months because of high rates of viral bronchitis

  • May be diagnosed with bronchiolitis
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4
Q

What is exercise-induced asthma?

A

Airway narrowing during or 5-10 minutes after vigorous exercise

  • Typically resolves within 1-4 hours
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5
Q

What medications should patients with exercise induced asthma use if they exercise daily?

A
  • Rescue inhaler
  • Add ICS
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6
Q

What are the different types of asthma?

A
  • Exercise induced
  • Occupational/environment induced
  • Allergen induced
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7
Q

What are the four classifications of asthma severity?

A
  • Intermittent
  • Mild persistent
  • Moderate persistent
  • Severe persistent
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8
Q

Symptoms associated with intermittent asthma

A
  • Symptoms occur 2x or less per week
  • Asymptomatic and normal PEF between exacerbations
  • Requires SABA 2 days/week
  • Exacerbations are brief
  • No interference with normal activity
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9
Q

How often do nighttime symptoms occur with intermittent asthma?

A

2x or less per month

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10
Q

Symptoms associated with mild persistent asthma

A
  • Symptoms occur >2x/week but <1x/day
  • Requires SABA >2 days/week but not more than 1/day
  • Exacerbations may affect activity (minor)
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11
Q

How often do nighttime symptoms occur with mild persistent asthma?

A

3-4x/month

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12
Q

Symptoms associated with moderate persistent asthma

A
  • Daily symptoms
  • Daily use of inhaled SABA
  • Some limitation
  • Exacerbations affect activity, 2x or >/week, may last days
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13
Q

How often do nighttime symptoms occur with moderate persistent asthma?

A

>1/week but not nightly

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14
Q

Symptoms associated with severe persistent asthma

A
  • Continual symptoms
  • Requires SABA several times/day
  • Extremely limited physical activity
  • Frequent exacerbations
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15
Q

How often do nighttime symptoms occur with severe persistent asthma?

A

Often, 7x/week

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16
Q

How does asthma classification in severity differ between adults and pediatrics?

A

Similar classification, however poorly controlled asthma (mild, moderate, severe persistent) requires a step up in medication

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17
Q

Pediatric asthma physical exam findings

  • Mild
A
  • Wheezing at the end of expiration or no wheezing
  • No or minimal intercostal retractions along posterior axillary line
  • Slight prolongation of expiratory phase
  • Normal aeration in all lung fields
  • Can talk in sentences
  • O2 saturation >92%
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18
Q

Pediatric asthma physical exam findings

  • Moderate
A
  • Wheezing throughout expiration
  • Intercostal retractions
  • Prolonged expiratory phase
  • Decreased breath sounds at the base
  • O2 saturation >92%
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19
Q

Pediatric asthma physical exam findings

  • Severe
A
  • Use of accessory muscles plus lower rib and suprasternal retractions
  • Nasal flaring
  • Inspiratory and expiratory wheezing or no wheezing heard with poor air exchange
  • Suprasternal retractions with abdominal breathing
  • Decreased breath sounds throughout base
  • O2 saturation <92%
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20
Q

How would the provider manage a patient with chronic asthma?

A
  • Reduce environmental/allergen exposures
  • Treat rhinitis, sinusitis, GERD
  • Yearly flu vaccine
  • Medications: anticholinergics, cromolyn sodium, leukotriene modifiers, omalizumab
  • Regular follow up with PCP after ED care
  • Education (asthma action plan)
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21
Q

True/false: The severity of asthma attacks will determine the management approach

A

True - response to initial treatment determines subsequent treatment

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22
Q

When are antibiotics warranted for patients with asthma?

A
  • Fever
  • PNA
  • Bacterial sinusitis
  • Purulent sputum
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23
Q

What should the provider do if PEF values are 50-79% of personal best (asthma management)?

A
  • Patient requires quick relief medication
  • Depending on response to treatment, contact with pulmonologist may be indicated
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24
Q

What should the provider do if a patient has a PEF value <50% (asthma management)?

A

Need for immediate medical care

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25
What are signs and symptoms of a serious asthma exacerbation?
* Marked breathlessness * Inability to speak more than short phrases * Use of accessory muscles * Drowsiness
26
What is initial treatment for an asthma exacerbation?
* Inhaled SABA (rescue inhaler) * Up to two treatments 20 minutes apart, 2-6 puffs by MDI, nebulizer
27
What is considered a good response to initial treatment of an asthma exacerbation? What further management is warranted at this time?
* No wheezing or dyspnea, PEF \>80% (after rescue inhaler use) * Contact PCP for follow up * Continue inhaled SABA every 3-4 hours for 24-48 hours * Consider short course of oral systemic corticosteroid
28
What is considered an incomplete response to initial treatment of an asthma exacerbation? What further management can the provider do?
* Persistent wheezing and dyspnea (tachypnea), PEF 50-79% * Add oral systemic corticosteroid * Continue inhaled SABA * Same day referral to PCP for further instruction
29
What is considered a poor response to initial treatment of an asthma exacerbation? What further management should be done by the provider?
* Marked wheezing and dyspnea, PEF \<50% * Add oral systemic corticosteroid * Repeat inhaled SABA immediately * If distress is severe and non responsive to initial treatment: call PCP and head to ED
30
What important information should be gathered in health history for patients with asthma?
* Family history of asthma/atopy * Conditions associated with asthma → GERD, sinusitis, chronic OM * Chest tightness/dyspnea * Cough/wheezing * Seasonal or continuous symptoms * Recurrent “bronchitis” symptoms or PNA * Precipitation of symptoms
31
Physical examination findings for asthma
* Wheeze * Cough * Prolonged expiratory phase * Diminished breath sounds * Increased work of breathing/signs of distress * VS * Cyanosis
32
True/false: Asthma is a diagnosis of exclusion
True - must include the following… * Episodic symptoms of airflow obstruction (wheeze, cough, SOB) * Evidence that airflow obstruction is at least partially reversible (trial of bronchodilator) * Exclusion of other conditions
33
Diagnostic tests for asthma
* Spirometry * Done in patients 5 years or older * PEFR and FEV1 * Peak flow meters * Used to monitor symptoms
34
When should spirometry be used for asthma diagnosis?
Recommended at the time of initial assessment, after treatment is initiated and symptoms and PEF have been stabilized, and at least every 1-2 years
35
True/false: Peak flow monitoring helps individuals to follow the course of their disease, predict exacerbations, identify triggers, assess response to treatment
True - should be used as the basis for an asthma action plan
36
How would a patient determine their personal best PEF with peak flow monitoring?
Can be estimated after a 2-3 week period * PEF is recorded at least once/day in early afternoon when asthma is well controlled
37
What are the cut offs for peak flow meter zones (green, yellow, red)?
Green → \>80% (90% for patients who decompensate quickly) Yellow → 50-80% (can be 60-80%) Red → \<50% (or 60%)
38
Management considerations for yellow zone (50-80%) readings on peak flow meter
* Continue with green zone medication and add quick relief medication * Temporary increase in medication dose or frequency * Increase bronchodilator therapy, increase or add corticosteroid, add short course of oral corticosteroid
39
Yellow zone (peak flow meter) signs
* First signs of a cold * Exposure to known trigger * Cough * Mild wheeze * Tight chest * Coughing at night
40
Red zone (peak flow meter) management
* Immediate use of inhaled rescue bronchodilator * Start or increase oral corticosteroid therapy * If symptoms persist, call 911 or go to ED
41
True/false: If asthma has been well controlled for 6 months, can “step down” in management
False - if well controlled for 3 months, can “step down”
42
What are some forms of reliever medications for asthma?
All patients need a reliever medication (bronchodilator) * Short acting beta agonist bronchodilator (SABA) * Low dose ICS/formoterol * Short acting anticholinergic
43
Examples of controller medications used for asthma control
* Inhaled ICS and long acting beta agonist bronchodilator combinations (ICS/LABA) * Long acting anticholinergic * Systemic corticosteroid
44
True/false: If a patient requires a rescue inhaler 4x/week or more, they will need controller medication
False - if using rescue inhaler 2x/week or more, will need controller medication
45
Stepwise approach to asthma management * Step 1
Reliever medication * As needed short acting beta agonist (SABA) for relief
46
Stepwise approach to asthma management * Step 2 (mild)
* Reliever medication: as needed SABA * Preferred controller medication: low dose ICS
47
Stepwise approach to asthma management * Step 3
* Reliever medication: as needed SABA or low dose ICS/formoterol * Preferred controller medication: low dose ICS/LABA
48
Stepwise approach to asthma management * Step 4
* Reliever medication: as needed SABA or low dose ICS/formoterol * Preferred controller medication: medium high dose ICS/LABA
49
Stepwise approach to asthma management * Step 5
Pulmonologist consultation
50
When are follow up visits warranted for patients with asthma?
* 1-3 months after starting treatment then every 3-12 months afterwards * If pregnant, follow up every 4-6 weeks
51
When is a referral to a pulmonologist warranted for patients with asthma?
* Diagnosis of asthma-related hospitalization * Poorly controlled asthma (e.g. frequent missed days of work and/or school) * Unresponsiveness to therapy * Second opinion * Periodic patient evaluation
52
What is COPD?
* Preventable and treatable disease characterized by airflow limitation * Progressive, not fully reversible * Predominately a smokers disease
53
COPD is a term used to describe two related lung disease. What are they?
* Chronic bronchitis * Emphysema
54
What is the difference between chronic bronchitis and emphysema?
Chronic bronchitis - frequent cough with mucus Emphysema - SOB
55
When in the lifespan does COPD typically present?
Usual onset in midlife and associated with long history of smoking * Slow progressing symptoms
56
COPD clinical presentation (symptoms)
* Dyspnea on exertion * Persistent and progressive * Worse with exercise * Cough * Sputum production
57
COPD physical examination findings
Suspected based on history and examination, but can be confirmed physiologically with simple spirometry * Skin → tobacco stains on fingers, clubbing * Pulmonary → inspiratory crackles, hyperinflation, forward sitting posture * Cardiac → RVH (cor pulmonale)
58
Gold standard diagnostic test for COPD
Spirometry * Forced expiratory time * FEV1/FVC \<0.70 (or \<70%) * FEV1 \<80%
59
Other diagnostic tests used to diagnose COPD (other than spirometry)
* Pulse oximetry * COPD assessment test * Chest x-ray * Hct and hbg * Blood gas measurements (if O2 sat \<92%) * Alpha-1 antitrypsin deficiency * Biomarkers * EKG (cor pulmonale)
60
What medication class should not be prescribed to patients with asthma or COPD?
Beta blockers
61
COPD management considerations
* Encourage smoking cessation * Oxygen therapy * Pulmonary rehabilitation * Exercise training * Psychological support * Nutrition → small frequent meals * Flu and pneumococcal vaccines * Palliative care (if end stage)
62
Pharmacotherapy management for patients with COPD
* Inhaled bronchodilators to relieve bronchospasm * Methylxanthine therapy to enhance bronchodilator therapy * Corticosteroids to reduce inflammation * Antibiotics for infection
63
COPD exacerbation medication management * Mild
SABA prn
64
COPD exacerbation medication management * Moderate
* SABA * Oral corticosteroid (prednisone) * Antibiotic (if indicated)
65
COPD exacerbation medication management * Severe
Go to ED for hospitalization

NURS 503 (10 decks)

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