Flashcards in Chapter 28 Obstructive Pulmonary Diseases Deck (164)
- Asthma is a heterogenous disease characterized by a combination of clinical manifestations along with?
- The variability of signs and symptoms can include episodes of?
- These episodes are associated with widespread but variable airflow obstruction that is usually reversible, either spontaneously or with treatment. The clinical course of asthma is unpredictable, ranging from?
- reversible expiratory airflow limitation or bronchial hyperresponsiveness.
- wheezing, breathlessness, chest tightness, and cough, particularly at night or in the early morning.
- periods of adequate control to exacerbations with poor control of symptoms
What is asthma?
Asthma is a chronic inflammatory disorder of the airways that results in recurrent episodes of airflow obstruction that it is usually reversible
The primary pathophysiologic process in asthma is persistent but variable?
inflammation of the airways. The airflow is limited because the inflammation results in bronchoconstriction, airway hyperresponsiveness (hyperreactivity), and edema of the airways
1) Although the exact mechanisms that cause asthma remain unknown, often exposure to a trigger, such as an allergen or irritant, initiates the?
2) precipitating factors of an acute asthma attack.
3) Asthma is not a?
1) inflammatory cascade.
2) Respiratory infections are also precipitating factors of an acute asthma attack.
3) Asthma is not a psychosomatic disease.
one’s immune responses may influence asthma development.
Common allergens include?
tree or weed pollen, dust mites, molds, furry animals, and cockroaches.
Asthma that is induced or exacerbated after physical exertion
Various air pollutants, cigarette or wood smoke, vehicle exhaust, elevated ozone levels, sulfur dioxide, and nitrogen dioxide can trigger asthma attacks. The role of outdoor air pollution as a cause of asthma is controversial.
Occupational asthma occurs?
after exposure to agents in the workplace. These agents are diverse and include wood dusts, laundry detergents, metal salts, chemicals, paints, solvents, and plastics.
- Most patients with asthma have a history of?
- what is more common in persons with asthma?
- allergic rhinitis.
- Gastroesophageal reflux disease (GERD) is more common in persons with asthma.
Certain drugs may?
The characteristic clinical manifestations of asthma are?
wheezing, cough, dyspnea, and chest tightness, particularly at night or early in the morning. Expiration may be prolonged. Examination of the patient during an acute attack usually reveals signs of hypoxemia
Asthma can be classified as?
intermittent, mild persistent, moderate persistent, or severe persistent, based upon current impairment of the patient and their risk for exacerbations.
Severe exacerbations of asthma can result in complications such as?
severe hypoxia, “silent chest,” and peak flow less than 40% of personal best.
A diagnosis of asthma is usually made based upon the?
presence of various indicators (i.e., clinical manifestations, health history, spirometry, peak flow variability)
- The goal of asthma treatment is to?
- Established guidelines give direction on the classification of severity of asthma at initial diagnosis and help determine?
- achieve and maintain control of the disease.
- which types of medications are best suited to control the asthma symptoms.
Asthma: A stepwise approach to drug therapy is based initially on the?
- Persistent asthma requires?
- Even persons with intermittent asthma should always carry?
- asthma severity and then on level of control.
- long-term (controller) therapy in addition to appropriate medications to manage acute symptoms (rescue).
- rescue medication
Asthma Medications are divided into two general classifications:
(1) long-term–control medications to achieve and maintain control of persistent asthma
(2) quick-relief (rescue) medications to treat symptoms and exacerbations
Because chronic inflammation is a primary component of asthma, what drugs are used?
inhaled corticosteroids are more effective in improving asthma control than any other long-term drug. Inhaled (ICS) agents, such as fluticasone (Flovent) and budesonide (Pulmicort), are first-line therapy for patients with persistent asthma.
Orally administered corticosteroids are indicated for?
acute exacerbations of asthma. Maintenance doses of oral corticosteroids may be necessary to control asthma in a minority of patients with severe chronic asthma.
Short-acting inhaled β2-adrenergic agonists, including albuterol, are?
the most effective drugs for relieving acute bronchospasm. They are also used for acute exacerbations of asthma.
Long-acting inhaled β2-adrenergic agonists, including salmeterol (Serevent) and formoterol (Foradil), are?
never to be used as monotherapy in asthma due to an increased risk of death. However, they are quite safe when combined with ICS such as fluticasone/salmeterol (Advair) or budesonide/formoterol (Symbicort).
Leukotriene modifiers can be used in?
milder asthma successfully as add-on therapy to reduce the dose of inhaled corticosteroids.
The only anti-IgE drug, which is omalizumab (Xolair), is used for?
difficult to treat moderate to severe asthma unable to be controlled by inhaled corticosteroids.
Methylxanthine (theophylline) preparations are?
less effective long-term control bronchodilators as compared with β2-adrenergic agonists and carry a high incidence of side effects.
Anticholinergic agents are?
not used in asthma treatment, except for ipratropium (Atrovent), which is only used in the ED for acute attacks.
The overall goals are that the patient with asthma will have asthma control as evidenced by?
minimal symptoms during the day and night, acceptable activity levels (including exercise and other physical activity), maintenance greater than 80% of personal best peak expiratory flow rate (PEFR) or forced expiratory volume in 1 second (FEV1), few or no adverse effects of therapy, no recurrent exacerbations of asthma, and adequate knowledge to participate in and carry out management.
Asthma: Education remains the cornerstone of asthma management. Your role in preventing asthma attacks or decreasing the severity focuses primarily on?
teaching the patient and caregiver.
One of the major factors determining success in asthma management is the correct administration of drugs.
♣ Inhalation devices include?
♣ Teaching should include information about medications, including the?
♣ Several nonprescription combination drugs are available over the counter. An important teaching responsibility is?
♣ Inhalation devices include metered-dose inhalers, dry powder inhalers, and nebulizers.
♣ Teaching should include information about medications, including the name, purpose, dosage, method of administration, schedule, side effects, appropriate action if side effects occur, how to properly use and clean devices, and consequences for breathing if not taking medications as prescribed.
♣ Several nonprescription combination drugs are available over the counter. An important teaching responsibility is to warn the patient about the dangers associated with nonprescription combination drugs.