Pulm: Asthma Flashcards by Anthony Carli

Asthma is characterized by what three pathophysiologic processes?

chronic inflammation
reversible obstruction
hyperresponsiveness

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80% of asthma sxs develop before what age?

5yo

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What are two major sxs for asthma?

Wheezing

Nocturnal, seasonal, cough longer than 3 weeks

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What medications can trigger asthma sxs?

Beta Blockers, ASA, NSAIDs

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If an asthma Dx is known, what questions must be included on patient hx? (5)

Medications
last use of inhaler
frequency of inhaler use
ED visits
hospitalization?

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A patient presents with…

Increased AP diameter
Wheezing
Rhinitis sxs
Atopic dermatitis

What should you consider?

Asthma

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What are 5 signs of severe obstruction in asthma?

tachypnea

tachycardia

Tripod

accessory muscle use

Pulsus paradoxus

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The following is called ______ triad and is associated with _______:

Sinus dz/nasal polyps

ASA sensitivity

Severe Asthma

Samter’s Triad

Aspirine Exacerbated Respiratory Disease

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The following is the _______ triad…

Atopic dermatitis
Allergic Rhinitis
Asthma

Atopic Triad

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atopic dermatitis –> food allergy –> allergic rhinitis –> Asthma

This is known as…

Atopic march

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The following are asthma DDx in what populations?

GERD
Allergic rhinosinusitis
URI
CF
Pertussis
FB or mass
RAD
CHD
Laryngotracheomalacia
Eosinophilic bronchitis

Infants and Children

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DDx in what populations?

GERD
COPD
CHF
PE
Vocal cord dysfuntion
Obstructive sleep apnea
chronic upper airway synd.
ACE-I cough

Adolescent and adults

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For what age is spirometry indicated?

> 5 yo

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A patient undergoes spirometry and has the following results:

FEV-1: < 80%
FEV-1/FVC: normal/decreased (70-85%)
Reversibility: > 12% or 8% in young children

Asthma

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What step of asthma?

Sx 2 or fewer days/week

FEV-1 > 80%

Infrequent nighttime awakenings

2 or fewer days/week of SABA use

Step 1: Intermittent Asthma

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What step of asthma?

Sxs 2+ days/week

3-5 nighttime awakenings

FEV-1 > 80%

Minor limitation of activity

2+ days of SABA use per week

Step 2: Mild persistent

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What step of asthma?

Daily sxs

Weekly nighttime awakenings

FEV-1 60-80%

FEV-1/FVC reduced 5%

daily SABA use

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Step 3: Moderate Persistent Asthma

What step of asthma?

Sxs throughout the day

Nightly awakenings

FEV-1 < 60%

FEV-1/FVC reduced by 5%

Extremely limited physical activity

SABA several times per day

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Step 4: Severe persistent asthma

What drug is an LTRA?

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Montelukast

For what ages is a LTRA used?

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0-4 yo

What two drugs are monoclonal antibodies?

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omalizumab

Benralizumab

Which drug is a methylxanthine?

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theophyline

Who should get a SABA?

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everyone

Which asthma step is managed with the following?

SABA prn

Consider low dose ICS (GINA)

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Step 1

Which asthma step is managed with the following? low dose ICS or LTRA/Cromolyn

Step 2

Which asthma step is managed with the following? consider specialist medium dose ICS OR low dose ICS + LABA/LTRA

Step 3

What is the GINA preferred tx for step 3 asthma?

medium dose ICS + ICS/LABA

Which asthma step is managed with the following? Refer to specialist Medium dose ICS + LABA/LTRA (0-4 yo)

Step 4

What is the GINA preferred tx for step 4 asthma?

medium/high dose ICS + LABA

Which asthma step is managed with the following? High dose ICS + LABA +/- Omalizumab (12+ with allergies) Sub LABA for LTRA (ages 0-4)

Step 5

In step 5 asthma, GINA recommends what SubQ med for pts 12+ with severe eosinophilic asthma?

benralizumab

Which asthma step is managed with the following? High dose ICS + LABA + PO Steroids +/- Omalizumab (12+ with allergies) Sub LABA for LTRA (ages 0-4)

Step 6

The Baylor Healthcare "Rules of Two" are... Yes to these questions indicate...

sxs 2 x week awaken at night 2 x month refil inhaler 2 x yearly peak flow < 2 x 10 (20%) from baseline? yes = uncontrolled

Is the following asthma profile well controlled, not well controlled, or very poorly controlled? Sx 2 or fewer / week Nighttime awakenings: - 0-11: 1 or less monthly - 12+: less than 2x month FEV-1: > 80% FEV-1/FVC: > 80%

Well controlled

Is the following asthma profile well controlled, not well controlled, or very poorly controlled? Sx 2+ days/week Nighttime awakenings: - 0-4: 1+ monthly - 5-11: 2+ monthly - 12+: 1-3 x weekly FEV-1: 60-80% FEV-1/FVC: 75-80%

Not well controlled

Is the following asthma profile well controlled, not well controlled, or very poorly controlled? Sx daily Nighttime awakenings: - 0-4: 1 x weekly - 5-11: 2+ weekly - 12+: 4+ x weekly FEV-1: < 60% FEV-1/FVC: < 75%

Very poorly controlled

Peak flow > 80% indicates...

Green zone, good control

Peak flow 50-80% indicates

yellow zone, caution

A yellow zone (50-80% peak flow) should be handled by...

SABA and consider changes to meds

Peak flow < 50% indicates

Red zone, emergency

What two diagnostics outside of PFTs can be helpful in diagnosing asthma?

ABG showing respiratory alkalosis CXR showing hyperinflation or to r/o infx/obstruction

How is an asthma exacerbation treated?

1. Oxygen 2. SABA/SVN (albuterol or xoponex +/- ipratropium) 3. systemic CS f/u 1 week

Pulm: Asthma Flashcards

(42 cards)