Pulm-Asthma

Question 1

Asthma

Answer 1

Path: Reversible inflammation and bronchoconstriction

Pt: SOB, wheezing, hyperresonant, prolonged expiration, exposure to trigger - (cold air, allergens).
CBC = eosinophilia, “nasal polyps”

Dx: Pulmonary function tests:
     FEV1/FVC decreased
     Reversible w bronchodilators
     Inducible w methacholine
Skin Test = identify triggers 

Tx: Beta-Agonists
-Short Acting
-Long Acting (never alone)
Steroids
-Inhaled corticosteroids 
-oral prednisone
Stabilizers 
-Nedocromil, Cromolyn
-Leukotriene Antagonists 

F/u: Avoid triggers

Question 2

Asthma exacerbation

Answer 2

Path: exposure to trigger

Pt: exposure to trigger = wheezing, dyspnea, prolonged exhalation
CBC = eosinopihlia; nasal polyps

Dx: Clinical, Peak-Flow

Tx: IV methylprednisolone
Albuterol + Ipratoprium
Steroid taper

F/u: Racemic Epinephrine
Magnesium
“stops wheezing” or “CO2 rising” (right arrow) intubate

Question 3

Chronic Asthma Treatment

Answer 3

I - SABA
II - SABA + ICS               LTA = ICS
III - SABA + ICS + LABA
IV - SABA + increased ICS + LABA
Ref. - oral prednisone

Question 4

Asthma Drugs

Answer 4

SABA - Albuterol
LABA - Formoterol, Salmeterol
ICS - Beclomethasone, Budesonide, Fluticasone, Mometasone
LTA - Montelukast, Zafirlukast 
Steroids - Prednisone (oral)