Asthma FINAL EXAM Flashcards
(65 cards)
What does AIR stand for?
-AIR: Anti-Inflammatory Reliever
f.e. ICS-formoterol (formoterol is long-acting but has quick onset -> can be used for rescue), ICS-SABA (not in USA)
-AIR only: ICS-formoterol used as needed for symptom relief (not for therapy)
How is AIR better than SABA alone for rapid symptom relief?
Reduces risk of exacerbation, compared to SABA alone
What does MART (SMART) stand for?
-MART: Maintenance and Reliever Therapy with ICS-formoterol for daily use; used for treatment (every day) + as needed
-SMART: same as MART, S stands for a single device
-ICS-formoterol can also be used before exercise or allergen exposure
What is Asthma?
-Airflow obstruction (like in COPD, but reversible)
-Bronchial hyperresponsivness
-Symptoms are variable and recurring
What is the hallmark of Asthma?
-Bronchial hyperresponsivness
-overreaction (constriction) of bronchioles to triggers (allergens, cold air, etc)
Which cells/molecules are involved in causing Asthma?
-Immune cells: T-lymphocytes, Macrophages, Eosinophils, Neutrophils, Mast cells, Epithelial cells
-Inflammatory mediators: Interleukin (f.e. IL-5), IgE (omalizumab), Chemokines, Leukotrienes, TNF-α, Nitric oxide
Pathophysiology of Airways in Asthma
-Constriction of the airway
-Wall inflamed and thickened
-Air trapped in Alveoli
What causes Asthma?
-Not proven
-Hygiene Hypothesis: less exposure of babies to microbes leads to less Th1 and more Th2 inflammatory profile
-Genetics: 60-80% of susceptibility related to genes
Atopy -> genetic predisposition to IgE-mediated response environmental antigens (strongest predisposing factor)
What are the long-term consequences of asthma?
-Airway remodeling leading to fibrosis and scarring of parenchyma (long tissue) -> can lead to COPD or other irreversible pathology
-Mucus overproduction: hyperplasia and hypertrophy of Goblet cells, epithelial cells slough off to mucus -> mucus plugs (can be deadly)
-Airway smooth muscle hypertrophy and hyperplasia - may contribute to hyperresponsiveness of bronchioles - treatment counteracts the hyperresponsiveness
Clinical presentation of asthma patients
-diverse: some pt with severe and some with mild asthma
-symptoms vary from complete remission to severe exacerbation (you never know when a pt will have an asthma attack)
How to diagnose asthma
-Pulmonary function test (PFT)
-Family history
Chronic Asthma Symptoms
-Shortness of breath (may be exercise-induced -> take puffs before exercising)
-Wheezing
-Chest tightness
-Chronic cough (at night)
-Dermatologic (eczema, inflammation of the skin)
-Allergic rhinitis
-symptoms worsen due to exercise or cold air, dry air
Acute asthma Symptoms
-Anxiety
-Severe shortness of breath
-chest tightness/burning
-tachypnea, tachycardia
-using accessory muscles for breathing
-pale skin
-doesn’t respond well to usual treatment
What are the different manifestations of asthma?
-chronic, underlying
-acute exacerbation: can occur in a few minutes and symptoms may persist for days
-exercise-induced: often triggered by cold and dry air
-nocturnal asthma: can be worsened by uncontrolled comorbidities: GERD, OSA (obstructive sleep apnea), sinusitis, environment, allergies, diurnal pattern of cortisol release
What are the risk factors for increased severity of asthma?
-Viral respiratory infections!!!
-Environmental exposure
-lower socioeconomic status
-Stress, depression
-Rhinitis/sinusitis
-Pregnancy, female hormones
-GERD
-Food allergies, Obesity
-Drugs
What are common drugs causing increased severity of asthma?
-Aspirin
-NSAIDs
-Non-selective ß-blocker
What are important questions to ask to assess for asthma (GINA guidelines)
-Daytime asthma symptoms more than twice a week?
-any night awakening due to asthma?
-SABA reliever for asthma more than twice a week?
-activity limitation due to the asthma?
Yes: 1-2x -> partially controlled asthma
Yes: 3-4x -> uncontrolled asthma
What are the goals of treatment?
-Symptom control
fewer asthma symptoms
no sleep disturbance
no exercise limitation
-Risk reduction
maintain normal lung function
reduce flare-ups (exacerbation)
prevent asthma deaths
reduce drug side effects
Peak Flow meter
-adjustable red light system (individual breathing performance)
-green: 80% of personal best, continue current therapy
-yellow: 50-80%, make changes to prevent worsening
-red: <50%, seek medical attention
How to use the Peak flow meter
-measures how fast and hard the air can be blown out of the lung
1. The marker should be at the bottom of the scale
2. stand or sit up straight, chin up, and look straight ahead
3. blow out and empty the lungs
4. breath in as much as possible
5. put the mouthpiece between teeth and close with lips tightly
6. blow out as hard and fast as you can
7. repeat 3x times and record the highest score
8. keep a record for two weeks (same time of the day when feeling well)
2Non-pharmacological approach for asthma
-reduce triggers
-control comorbidities
-education of self-management
-Health maintenance:
->vaccines: Influenza (anyone under 6), pneumococcal (before 65 with asthma), COVID, RSV
What is the long-term treatment of asthma?
-Inhaled Corticosteroids
-3 categories: Low, Medium, High dose (use to the lowest possible dose)
-patients concerned about linear growth in children (no risk according to literature)
-counsel on oral care (candidiasis)
Steroid dose-depending effect
-the dosing is not linear to the magnitude of the effect
-no doubling of effect when increasing the dose
-low dose preferred
QUESTION
-should asthma be treated by regular drug intake (like COPD)
-any harm in taking too much of bronchodilators
-is the efficacy reduced after time, when taking the drug more often than directed
-What is a good way to help in acute asthma episodes that could not be controlled by albuterol? give IV prednisone -> PO Prednisone
-When is it appropriate to recommend a nebulizer? -> EXACERBATION
-Can ICS-Formoterol be used for Stage 3 as MERT and as a short term reliever at the same time, or should DIFFERENT bronhodialtor be used for rescue treatment?
