pulmonology Flashcards
(26 cards)
asthma is
reversible hyperirritability of the tracheobronchial tree
airway inflammation and bronchoconstriction
MC chronic childhood disease
asthma
samter’s triad
asthma
nasal polyps
ASA/NSAID allergy
samters triad is associated with
atopic dermatitis
three main components of the pathophysiology of asthma
airway hyperreactivity
bronchoconstriction
inflammation
airway hyperreactivity and asthma
endogenous and exogenous stimuli
early IgE mediated and later T cell-mediated
extrinsic: allergen triggers ( increased IgE)
intrinsic: nonallergic (infection, pharmacologic)
bronchoconstriction and asthma
airway narrowing due to smooth muscle constriction, bronchial wall edema, thick mucus secretions.
Mucus plugs and airway remodeling lead to air trapping and obstruction: decreased expiratory airflow, increased resistance and V/Q mismatch
inflammation and asthma
cellular infiltration (T lymphocytes, neutrophils, eosinophils) and their proinflammatory cytokines (leukotrienes); increase histamine release from mast cells (IgE mediated)
classic triad for asthma
dyspnea
wheezing
cough (especially at night)
physical exam of asthma
prolonged expiratory wheeze, hyperresonance to percussion, decreased breath sounds, tachycardia, tachypnea and use of accessory muscles
physical exam of severe asthma and status asthmatics
inability to speak in full sentences, PEFR <40%, altered mental status, pulses paradoxus (inspiratory decrease of SBP >10), cyanosis, tripod position, silent chest (no air exchange), tachycardia, severe tachypnea
Gold standard for asthma testing
pulmonary function test
reversible obstruction
what test to use if pulmonary function testing is non-diagnostic
bronchoprovocation
methocholine challence test
The best and most effective way to evaluate asthma exacerbation severity and patient response in ED
peak expiratory flow rate
response to treatment is >15% from initial attempt
normal range for PEFR
400-600
Pulse ox that is indicative of respiratory distress
less than 90%
acute asthma rescue drug classes (3)
SABA
anticholinergics
corticosteroids
first line treatment for acute asthma exacerbations
SABA effective and fastest (2-5 min)
list of SABAs
albuterol
Terbutaline
Epinephrine
SABA MOA
bronchodilators (especially peripherally)
decreases bronchospasm
inhibits the release of bronchospastic mediators
increases ciliary movement
decreases airway edema and resistance
side effects of SABA
B1 cross reactivity: tachycardia/arrhythmias, muscle tremors, CNS stimulation
route of administration of SABA
nebulizer in ED
reevaluate after 3 doses
anticholinergic for acute asthma drug list
ipratropium
MOA of anticholinergics
central bronchodilator (inhibits vagal-mediated bronchoconstriction) and inhibits nasal mucosal secretions. Most useful in the first hour
