3: Asthma

Question 1

Amount of air exhaled in the 1st second of forced exhalation.

Answer 1

Forced Expiratory Volume (FEV1)

Question 2

Total volume of air exhaled during a forced expiratory effort.

Answer 2

Forced Vital Capacity (FVC)

Question 3

Adjusts for FVC.

Answer 3

FEV1/FVC Ratio

Question 4

In the absence of an acute episode, what could be expected to be found on the PE in regards to lung sounds and AP diameter?

Answer 4

• Anteroposterior diameter is increased because of hyperinflation and there may be an abdominal breathing pattern.
• Lung Assessment:
  
  • Prolongation of the expiratory phase
  • Expiratory wheezing
  • Coarse crackles
  • Unequal breath sounds
• Child who is not sick:
  
  • Forced exhalation may reveal expiratory wheeze
  • Ask to blow hard or push on abdomen

Question 5

A family hx of which 5 conditions could be indicators for asthma?

Answer 5

1. Asthma
2. Allergy
3. Sinusitis, rhinitis
4. Atopic dermatitis
5. Nasal polyps

Question 6

What peak expiratory flow rate is the red zone, indicating major airflow obstruction?

Answer 6

<50% of personal best or predicted.

Question 7

Name precipitating or aggravating factors for asthma.

Answer 7

1. Viral infections
2. Environmental allergens
3. Irritants (e.g., smoke exposure, chemicals, vapors, dust)
4. Exercise
5. Emotions
6. Home environment (e.g., carpets, pets, mold)
7. Stress
8. Drugs (e.g., aspirin, beta blockers)
9. Foods
10. Changes in weather

Question 8

Pulmonary function tests are _____ in patients younger than 5 years old.

Answer 8

Pulmonary function tests are not reliable in patients younger than 5 years old.

Question 9

T/F Spirometry or bronchoprovocation required for asthma diagnosis.

Answer 9

False. Helpful, but not required for diagnosis.

Question 10

What 3 criteria must be met to diagnose asthma?

Answer 10

1. Episodic symptoms of airflow obstruction are present.
2. Airflow obstruction or symptoms are at least partially reversible.
3. Alternative diagnoses are excluded.

Question 11

What are the symptoms of asthma?

Answer 11

• Wheezing
• Cough
• Cough at night
• Cough during or after exercise
• Shortness of breath
• Chest tightness
• Sputum production

Question 12

What FEV1/FVC ratio indicates obstruction?

Answer 12

<80%

Question 13

When would eosinophil counts and IgE levels be useful in the diagnosis of asthma?

Answer 13

When allergic factors are suspected.

Question 14

What peak expiratory flow rate is the green zone, indicating good control?

Answer 14

80-100% of personal best or predicted.

Question 15

T/F Chronic symptoms and signs of reversible bronchospasm are required for asthma diagnosis.

Answer 15

False. >3 episodes of reversible bronchospasm or chronic symptoms.

Question 16

_____ is the essential objective measure for establishing the diagnosis of asthma.

Answer 16

Spirometry is the essential objective measure for establishing the diagnosis of asthma.

Question 17

These are signs of what?

• Atopic dermatitis/eczema
• Conjunctival congestion and inflammation
• Ocular shiners
• Transverse crease on the nose due to constant rubbing
• Pale violaceous nasal mucosa

Answer 17

Atopy or allergic rhinitis

Question 18

T/F In a PE of a patient with asthma who is not having an exacerbation, abnormal findings are expected.

Answer 18

False. In mild asthma, there may be normal findings. In severe asthma, signs of chronic respiratory distress and chronic hyperinflation may be present.

Question 19

What are the patterns to asthma symptoms?

Answer 19

• Perennial, seasonal, or both
• Continuous or intermittent
• Daytime or nighttime
• Onset and duration

Question 20

What peak expiratory flow rate is the yellow zone, indicating caution?

Answer 20

50-80% of personal best or predicted.

Question 21

T/F Asthma is an isolated condition not affected by other disease processes.

Answer 21

False. Asthma can be affected be these other diseases:

• Thyroid disease
• Pregnancy
• Menses
• Gastroesophageal reflux disease (GERD)
• Sinusitis
• Rhinitis