Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pulm > Lecture 6: Asthma > Flashcards

Lecture 6: Asthma Flashcards

1
Q

Define asthma.

A

Reversible, obstructive lung disease caused by increased airway sensitivity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What pathophysiologic characteristics are seen in asthma?

A
  • Inflammatory cell infiltration with eosinophils, neutrophils, and T-lymphocytes.
  • Goblet cell hyperplasia
  • Thick mucus plugging small airways
  • Hypertrophy of smooth muscle
  • Airway edema
  • Mast cell activation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two physical factors that ultimately lead to asthma?

A
  • Airway obstruction
  • Bronchiole constriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the strongest, identifiable, predisposing factor for development of asthma?

A

Atopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the risk factors for asthma?

A
  • Obesity
  • Respiratory irritants
  • Pollutants
  • Weather (cold)
  • Environment
  • GERD
  • Viruses
  • URIs
  • Exercise
  • Stress
  • BBs
  • NSAIDs/ASA
  • FMHx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When does most asthma begin by?

A

< 5 years of age

77%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What asthma type is uncommon and typically idiopathic?

A

Intrinsic asthma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What confirms a diagnosis of asthma?

A

Spirometry w/ reversibility test.

Usually not done until age 5

Can also do allergy testing.

Perform normal spirometry
Give BD and then perform spirometry again.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the primary S/S of asthma?

A
  • Cough
  • Chest tightness
  • SOB/Dyspnea
  • Difficulty breathing
  • Episodic wheezing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do nasal polyps in the nose for a suspected asthmatic child suggest?

A

CF

In an adult, might just be benign.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What PE findings might suggest asthma?

A
  • Nasal secretions/mucosal swelling and/or nasal polyps
  • Atopy, ocular shiners, salute sign
  • Wheezing, prolonged expiratory, hyperexpansion of thorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

On a lung exam, what should be documented regarding the 4 parts of a lung exam?

A
  • Inspection: shape and movement
  • Palpation: reduced if hyperinflated, maybe reduced tactile fremitus
  • Percussion: normal to hyperresonant
  • Auscultation: Rhonchi to wheeze, prolonged expiratory, or even silent chest in severe.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

For a child >= 5 years old, what is the spirometry criteria to diagnose asthma?

A
  • Reduced FEV1/FVC (< 85% for a child)
  • Increased FEV1 post BD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What substances does bronchoprovocation testing use to induce an asthma attack?

A
  • Histamine
  • Methacholine challenge test
  • Mannitol

Not indicated if FEV1 < 65%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What at home testing is good to monitor asthmatics with?

A

Peak flow meters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When are CXRs indicated for asthma?

A
  • Initial diagnosis of asthma
  • Uncertain diagnosis from PFT
  • Refractory acute asthma attack/status asthmaticus to r/o other causes and complications.

MC finding is nothing!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What might we see elevated in a CBC for asthma?

A
  • Eosinophils
  • IgE as well.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What might be seen in a sputum culture/sample of an asthma patient?

A
  • Charcot-Leyden crystals (Crystals of eosinophils)
  • Curschmann spiral (Shed epithelium)

Both are specific to asthma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the methacholine challenge and what is a significant finding?

A
  • Inhalation of increasing methacholine dosages and PFTs.
  • Increased airway hyperresponsiveness with a >= 20% decrease in FEV1 per max dose.

Only inpatient and expensive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the golden rule about asthma?

A

All wheezes are not asthma!

Could be a far more severe condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is tussive syncope?

A

Fainting from coughing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the criteria for mild intermittent asthma?

A
  • daytime symtoms <=2 days/week
  • <=2 night awakenings/month
  • use of SABA <=2 days/weeks
  • No functional impairment between exacerbations.
  • FEV1 >= 80% between exacerbations.
  • FEV1/FVC normal between exacerbations.
  • 0-1 exacerbations requiring oral glucocorticoids per year.

Essentially, asthma attacks happens 2 or less times a week and it doesn’t affect you otherwise.

23
Q

What is the criteria for mild persistent asthma?

A
  • daytime symptoms more than twice a week (not daily)
  • 3-4 night awakenings per month
  • use of SABA > twice a week
  • Minor interference with normal activities
  • FEV1 normal and FEV1/FVC normal
  • 2+ exacerbations requiring oral glucorticoids annually.

Essentially, more frequent than mild intermittent, but not heavily impactful on your day-to-day

24
Q

What is the criteria for moderate persistent asthma?

A
  • Daily symptoms
  • Nighttime awakenings > once a week
  • Daily SABA use
  • Minor limitations in normal activities
  • FEV1 60-80% and FEV1/FVC lowered.

Not able to go on a run.

25
What is the criteria for severe persistent asthma?
* Daily symptoms * Nighttime awakenings nightly * Multidaily SABA use * Extremely limited * FEV1 <=60%, FEV1/FVC below normal.
26
When is levalbuterol used over albuterol?
Presence of cardiac issues (It should have less cardiac SEs) | However, it is more expensive. ## Footnote Main SEs of SABAs: Tachycardia Nervousness Shakiness I emailed Davis about it and she said its just a clinical pearl, won't be tested on. Articles say it has no diff in SE.
27
What are the inhaled corticosteroids used for asthma?
* Budesonide/pulmicort (Neb/Inhaler, so it can be used in children/babies) * Beclometasone/Qvar (inhaler only) * Mometasone furoate/Asmanex (inhaler only) * Fluticasone propionate/Flovent (inhaler only) | Preferred long-term controller
28
What are the most common SEs with inhaled corticosteroids?
* Thrush * Hoarseness * Localized hypersensitivity * Cough and throat irritation | Rinse mouth out after use. ## Footnote Also caution about systemic symptoms.
29
What medical history is pertinent in prescribing an ICS?
* H/o of glaucoma * Growth levels (BMI < 15) * Calcium and Vit D intake
30
What ICS inhalers are recommended in pregnant women?
* Budesonide | Can also use albuterol/proventil, but ICS is preferred.
31
What are the systemic corticosteroids used for acute asthma attacks?
* Prednisone (pill) * Prednisolone (liquid) * Solumedrol (IM/IV) | PO preferred if no IV access. ## Footnote Oral and IV have the same onset for these meds.
32
What are the SEs of systemic corticosteroids?
* SSTI * Cushing/weight gain * Cataracts/glaucoma * CV disease * GI disease * Hyperinsulinemia w/ insulin resistance
33
When are LABAs used?
Already on a SABA and ICS. Adjunct therapy ## Footnote Salmeterol Formoterol Arformoterol But usually combined with an ICS in a combo.
34
What additional SEs can LABAs cause over SABAs?
* Cramping of hands/legs/feet * Overuse can worsen symptoms
35
For an acute asthma attack nonresponsive to a SABA, what is the usual next step?
Anticholinergics, such as: * Ipratropium bromide (atrovent) * Tiotropium bromide * Ipratropium and albuterol | Relax airway, prevent narrowing, and reducing mucus.
36
What is theophylline?
* A non-selective phosphodiesterase enzyme inhibitor. * Enhances mucociliary clearance and anti-inflammatory. | Mainly only in mod-severe asthma. Need to monitor serum concentrations.
37
What are the leukotrienes and their MOA?
* Montelukast/singulair * Zafirlukast/accolate MOA: Leukotriene receptor antagonist ## Footnote Overall, improves symptoms, reduces exacerbations, and limits markers of inflammations such as eosinophil counts.
38
When is cromolyn used and what is it?
* Used when intolerant of ICS for asthma. * Mast cell stabilizer * Reduces airway reactivity. | Neb only.
39
What is racemic (nebulized) epi mainly used for?
* Severe Croup * Last resort for severe asthma | Slightly more beta-2 agonist. ## Footnote Racemic = quick peak, quick onset, 1-3 hours and then it is gone. Need to monitor after administration for 4 hours!!!!!!
40
What MAB is used for asthma?
Omalizumab/Xolair. Injectable that targets IgE mast cells. | Must be an allergy-related asthma. ## Footnote Also used in chronic, idiopathic urticaria. Can cause anaphylaxis as BBW.
41
In general, what would you first prescribe to a newly diagnosed patient with asthma over 12 yo?
* SABA PRN * Low dose ICS daily or PRN w/ SABA.
42
What are the 6 steps of asthma treatment?
1. SABA + low dose ICS when symptomatic or low dose daily. 2. SABA + low dose ICS 3. SABA + low dose ICS + LABA OR medium dose ICS only. 4. SABA + medium dose ICS + LABA 5. SABA + high dose ICS + LABA/montelukast 6. SABA + high dose ICS + LABA/montelukast + oral steroids + (consider MAB) ## Footnote AKA start with a SABA and low dose ICS and slowly go up.
43
How often is asthma followed up on?
* Routine: 1-6 months * Adjusting meds: 2-6 weeks ## Footnote Once stable for 3+ months, consider stepping down treatment.
44
What ethnicities have lower predicted values on peak flow meters?
* Black * Hispanic | 10% lower predicted
45
How do we determine asthma control?
How often they have symptoms weekly.
46
At what asthma step do you refer out to pulm or an allergist?
* > 5 yo = step 4 or higher (SABA + med dose ICS + LABA) * < 5 yo = step 3 or higher (SABA + low dose ICS + LABA or med dose ICS
47
What is Exercise Induced Asthma? (EIA)
* Airway narrowing during vigorous exercise * usually at onset of exercise or within a few mins.
48
How do we treat EIA?
Trial SABA
49
What is cough variant asthma and how we do treat it?
* Chronic non-productive and nocturnal cough > 3 weeks. * Treated same as asthma | Generally a r/o cause. ## Footnote Usually normal PFTs.
50
What are the warning S/S for an acute asthma attack in an adult?
* Increased SOB or wheezing * Disturbed sleep * Angina/tightness * Increased SABA use * Fall in peak flow rate
51
What are the warning S/S for an acute asthma attack in a child?
* Audible wheezing/whistling * Coughing frequently or in spasms * Waking at night * SOB * Chest tightness
52
What is status asthmaticus?
* Most severe form of asthma. * Lungs are inadequate to provide adequate perfusion * Leads to organ dysfunction and ARDS * Requires intubation and ventilator support.
53
How is an acute asthma attack treated in office?
1. Nebulized albuterol + O2 check 2. 2nd neb (duoneb) + O2 check 3. 3rd neb + O2 check | If not > 94% or in severe distress still, refer to ER. ## Footnote 3 neb treatments is only for mild-mod.

Pulm (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions