Asthma highlights

Question 1

1) List 4 common causes of chronic cough in adults
2) Name 1 less common cause of chronic cough
3) Name the 4 least common causes

Answer 1

1) Asthma, COPD, Smoking, Post infectious (CAP, bronchitis, etc)
2) OSA
3) Cancer
IPF, sarcoidosis
Lung abscess
PTX

Question 2

What is the triad of asthma risk factors?

Answer 2

1) Infant atopic dermatitis,
2) Childhood AR
3) Asthma

Question 3

1) Are asthma Sx episodic or chronic? Explain
2) Is the airway obstruction reversible?

Answer 3

1) Episodic Sx, but chronic airway inflammation
2) Yes; Reversible Airflow obstruction

Question 4

For asthma:
1) Onset
2) Duration
3) Characterization

Answer 4

1) Typically during childhood (male), adult onset less common (female)
2) Chronic with episodic flare ups
3) Reversible airway obstruction

Question 5

Asthma is heterogenous; what is the most common phenotype?

Answer 5

Allergic asthma

Question 6

Breast feeding is associated with ___________ risk of asthma

Answer 6

reduced

Question 7

What is the Samter Triad?

Answer 7

1) ASA/NSAID sensitivity
2) Nasal polyp
3) Asthma

Question 8

List the onset, duration & timing, and character of asthma presentation (OLDCARTS pt 1)

Answer 8

1) Onset: typically as child/teen but manifest in adults
2) Duration, Timing: chronic but episodic, variable severity (mild intermittent to persistent symptoms), daytime and or nighttime symptoms
Location: respiratory
3) Character: reversible episodic symptoms - tightness in chest, wheezing, dyspnea, coughing (usually dry cough)

Question 9

List the aggravating factors, alleviating factors, radiation and assoc. Sx of asthma presentation (OLDCARTS pt 2)

Answer 9

1) Triggers (smoke, smells, allergens, stress, aspirin, exercise), to include RTI
2) Relaxation, avoidance of triggers
3) Typically isolated to respiratory system
4) Atopic dermatitis/eczema, allergic rhinitis, nasal polyps, snoring

Question 10

True or false: Asthma VS & Chest exam may be normal between episodes

Answer 10

True

Question 11

Severe asthma exacerbation
1) What is a concerning finding for impending respiratory failure?
2) What are other signs of severe asthma exacerbations? What may cause these signs?

Answer 11

1) Globally reduced breath sounds and prolonged expiration
2) Patient in acute distress, cyanotic, hypoxic, and mental status changes (confusion)
-Pulse oximetry indicating hypoxia < 90%

Question 12

1) What should be performed in all pts at time of Dx?
2) What is this key for?
3) What should you do if pt is <5 y/o and can’t do this test?

Answer 12

1) Should be performed in all patients at time of diagnosis
2) To confirm diagnosis
3) A therapeutic trial of Rx is recommended as they can not perform spirometry

Question 13

1) Define FEV1% predicted
2) Define FEV1/FVC

Answer 13

1) FEV1 as % of predicted FEV1 using demographic data (age, Ht., gender, & race)
2) Measure of obstruction as a %

Question 14

What is the spirometry diagnostic criteria for asthma in adults?

Answer 14

1) Reversibility indicated by FEV1 % predicted increased >/= 12% post SABA
AND
2) FEV1 Increase of 200 mL

Question 15

What is the spirometry diagnostic criteria for asthma in kids <12 y/o?

Answer 15

FEV1 % predicted increased >/= 12% post SABA (Reversibility)

Question 16

Spirometry reports:
1) What are used for predicted values?
2) Differentiate between base and base +
3) Differentiate between post and post +

Answer 16

1) Demographics used for predicted values
2) Base = pre-SABA
Base + = best values from 3 trials
3) Post = post SABA
Post + = best values from 3 trials

Question 17

National asthma education & prevention program (NAEPP) recommends classifying asthma ___________ based on reported asthma symptoms at diagnosis to determine ___________ __________.

Answer 17

severity; initial therapy

Question 18

NAEPP recommends recommends assessing degree of asthma __________ using validated clinical tools

Answer 18

control

Question 19

Based on severity and control of asthma symptoms, use a _____________ approach for therapy

Answer 19

step wise

Question 20

For NAEPP step 2 (mild persistent asthma), what should you Rx?

Answer 20

PRN ICS + SABA

Question 21

For NAEPP step 3+ in pts >4 y/o, what should be considered as a daily and rescue Rx?

Answer 21

SMART therapy

Question 22

SABA increases FEV1 in _________ minutes

Answer 22

3-5

Question 23

Short acting antimuscarinic antagonist(SAMA):

Answer 23

Slower onset of action than SABA when used as monotherapy , ~ 15 minutes,

Question 24

The most effective maintenance Rx is what? Why?

Answer 24

ICS (inhaled corticosteroids); addresses inflammatory component of asthma

Question 25

What are the 2 ways to use ICSs?

Answer 25

PRN or scheduled use + SABA OR part of SMART Rx

Question 26

1) When can you use oral corticosteroids? 2) Give examples of oral corticosteroids 3) How long should you use these?

Answer 26

1) Typically reserved for acute exacerbations that do not respond to increase in step therapy 2) Prednisolone, Dexamethasone, Methylprednisolone 3) Limited to 3-7 days

Question 27

______________ is not typically recommended as monotherapy for asthma (has FDA warning of increased hospitalization, Intubation, & death)

Answer 27

LABA

Question 28

What is **not** typically recommended as monotherapy or 1st line add on to ICS for asthma?

Answer 28

Long-acting muscarinic antagonist(LAMA)

Question 29

1) Name a Leukotriene receptor antagonist (LTRA) 2) Do they work as monotherapy?

Answer 29

1) Singular (montelukast) 2) Yes, but ~half as effective as ICS

Question 30

How is formoterol classified?

Answer 30

LABA; has duration of LABA, but the onset of action of a SABA

Question 31

Montelukast has FDA warning regarding what?

Answer 31

Behavior, mood, & suicide

Question 32

What does SMART stand for?

Answer 32

Single medication for Maintenance And Rescue Therapy

Question 33

True or false: at follow-up asthma visits you should asses with both the ACT (asthma control test) and GINA

Answer 33

True

Question 34

Singular (montelukast) MOA?

Answer 34

Block action of leukotriene at receptor (LTRA)

Question 35

What is the best option when ICS monotherapy isn't enough?

Answer 35

Add LABA (formoterol) to ICS (via SMART therapy >4 y/o)

Question 36

For allergic asthma, _________________ immunotherapy may be considered for adjunct therapy in patients 5 + y/o with mild to moderate persistent asthma with proven allergies

Answer 36

subcutaneous

Question 37

What type of immunotherapy is not recommended or FDA approved for asthma?

Answer 37

Sublingual immunotherapy

Question 38

What should you check in severe asthma? Why?

Answer 38

1) Serum eosinophiles & IgE levels 2) IgE mediated allergic asthma responsible for ~ 50% of difficult to control asthma

Question 39

What do all monoclonal antibodies have in common as far as naming conventions go?

Answer 39

all end in -mab

Question 40

List the 4 types of pneumococcal vaccine and what type each is

Answer 40

Pnemococcal conjugate vaccines: 1) PCV-15 = Vaxneuvance 2) PCV-20 = Prevnar-20 3) CV-21 = Capvaxive Pneumococcal polysaccharide vaccine: 4) PPSV-23 (Pneumovax 23)

Question 41

What vaccines should asthma patients get? (4) What else should they do? *not highlighted, just emphasized in class*

Answer 41

1) Influenza: annual 2) COVID-19: annual? 3) RSV for 60+: q 2 years? 4) Pneumococcal: early in high risk -Quit smoking

Question 42

1) For adults 50+, the new recommendation includes the option of a PCV 15 followed in _________ by PPSV 23. 2) For high risk patients after childhood vaccination, when can they

Answer 42

1) 1 year 2) PCV 15 followed in 8 weeks by PPSV 23

Question 43

Differentiate b/t Tdap and DTaP: 1) What is Tdap? How is it different from DTaP? 2) What is the purpose of DTaP? 3) What is the purpose of Td?

Answer 43

1) Tdap is a booster for already vaccinated with DTaP Has lower dose. 2) DTaP is to provide primary vaccination/immunity against diphtheria, tetanus, and pertussis 3) Td is a booster just for tetanus and diphtheria

Question 44

What are the 5 As of smoking cessation? **"need to know"**

Answer 44

Ask: every patient every visit if they smoke Advise: every smoker to quit Assess: willingness to cut back or quit Assist: with FDA approved Rx -Nicotine replacement: gum, lozenges, patches -Wellbutrin SR (Zyban) -Varenicline (Chantix) Arrange follow up: in person, tele-med, phone, text, email, etc.

Question 45

True or false: Inadequate control of asthma poses a greater risk to the fetus than asthma medications

Answer 45

True

Question 46

Asthma in pregnancy: 1) Preferred rescue? 2) Preferred controller?

Answer 46

1) Albuterol is the preferred rescue 2) ICS are preferred controller (budesonide preferred)

Question 47

True or false: There are different severities of asthma exacerbations

Answer 47

True

Question 48

What two things must a pt have regarding asthma exacerbation plans?

Answer 48

1) Patient should have and follow written asthma action plan AND 2) Must have the medication on hand

Question 49

Home based asthma management is based on what?

Answer 49

Written asthma action plan