Asthma

Question 1

What is asthma?

Answer 1

Inflammation and bronchoconstriction causing airway issues.

Mucous production also worsens the obstruction

Question 2

Airway hyperresponsiveness

Answer 2

Exaggerated bronchoconstriction response to stimuli

Question 3

Airway edema

Answer 3

Edema, mucous production, formation of thickened mucous plugs.

Question 4

Patient hx suggesting asthma?

Answer 4

Symptoms that occur w/ exposure to triggers, and resolve with avoidance of trigger.

Question 5

Symptoms of asthma

Answer 5

Cough
End-expiratory wheezing
SOB
Symptoms may be seasonal or diurinal

Question 6

Pathophysiology of Asthma

Answer 6

1. Eosinophils promote airway hyper-responsiveness.
2. Lymphocytes produce cytokines and leukotrienes.
3. Mast cells arouse IgE receptors.

Question 7

The fundamental problem with asthma is ____, NOT _____

Answer 7

AIrway inflammation, not bronchospasm

Bronchospasm arises from airway inflammation

Question 8

Asthma triad

Answer 8

Wheezing
Chronic episodic dyspnea
Chronic cough

Question 9

Associated symptoms of asthma

Answer 9

Tachypnea, tachycardia, HTN
Harsh respirations, wheezing
Sputum production
Chest pain/tightness
Diminished breath sounds
Sometimes only happens at night

Question 10

Dx of asthma

Answer 10

1. Hx of asthma symptoms
2. S/S suggestive of asthma
3. Confirmation with spirometry
4. Exclusion of other diagnoses

Question 11

Spirometry

Answer 11

• Order before and after bronchodilators
• Can also have pt monitor at home.
• Positive bronchodilator response is when test is better after application of bronchodilator

Question 12

Which blood test would you use to dx asthma?

Answer 12

1. There are no blood tests for asthma. IgE may be increased, but this is not necessary to diagnose asthma.
2. May want to R/O anemia

Question 13

Bronchoprovocation test

Answer 13

Or metacholine test

Inspiration of known trigger to induce a response

Question 14

Extrinsic Asthma

Answer 14

Atopic Asthma

1. Initiated by type I hypersensitivity.
   - Most common
   - generally occurs in first 2 decades of life.
   - associated w/ other allergic manifestations
   - IgE and eosinophil counts are usually elevated

Question 15

Most common causes of cough.

Answer 15

1. GERD
2. Post nasal drip
3. asthma

Question 16

6 questions to assess degree of asthma control.

Answer 16

1. Have you taken oral glucocorticoids to asthma in the past year?
2. Have you been hospitalized/intubated form asthma in the last year?
3. How many ED visits for asthma in the last year?
4. Do you smoke?
5. Any increase in S/S after ASA/NSAIDS?
6. What is your normal peak flow?

Question 17

Peak flow Green zone

Answer 17

80-100% of the pt’s normal peak flow signals all clear.

Asthma is under control

Question 18

Peak flow yellow zone

Answer 18

1. 50-80% of the normal peak flow signals caution.
2. patient may require extra treatment
3. Have a plan for yellow zone readings

Question 19

Peak flow red zone

Answer 19

Less than 50% of normal.
Immediate actions need to be taken.
Take rescue medications right away

Question 20

Beta-2 agonists stimulate ______ ______ receptors.

Answer 20

Beta-androgenic

Question 21

Beta-2 agonists

Answer 21

• Produce airway dilation.

- Can be long or short acting

Question 22

Short-acting beta-2 agonist

Answer 22

• Albuterol, Proventil, Ventolin
• Most widely-used beta-agonist
• Rescue medication
• Quick onset, lasts 4-6 hours

Question 23

Increasing albuterol use to one canister or 200 puffs/month signals?

Answer 23

• Lack of adequate asthma control

- More frequent use=more adverse SE

Question 24

Adverse effects of beta-2 agonists

Answer 24

• tachycardia
• tremor
• hypokalemia
• HA
• Hyperglycemia
• Increased lactic acid

Question 25

Long-acting beta-2 agonist

Answer 25

Salmeterol (Serevent) Formoterol (Foradil) NOT rescue drugs ... used for long-term effects

Question 26

MOA of long-acting Beta-2

Answer 26

``` Slower onset (30 mins) Longer lasting (9-12 hrs) ```

Question 27

Non-selective beta agonists

Answer 27

``` Not recommended for asthma -Epinephrine (emergent use) -Isoproterenol -Metrapel -Loetharine Many adverse cardiac SE ```

Question 28

Ipratropium Bromide (atrovent)

Answer 28

- May enhance bronchodilation - Use in combination w/ beta-agonist - Slow to act (60-90 mins) - Synergistic with albuterol - Minimal SE

Question 29

Tiotropium (Spiriva)

Answer 29

``` Same profile as Ipatropium Bromide Longer acting (24 hrs) ```

Question 30

Theophylline

Answer 30

Out of favor, but still in guidelines Methylxanthine bronchodilator IV or oral

Question 31

Corticosteroids

Answer 31

- Fluticonase (flonase) and others - Anti-inflammatory: reduces airway inflammation - Can be used with acute (IV) or chronic illness

Question 32

Inhaled steroids

Answer 32

- Reduces airway reactivity - Start in any patient who is not controlled by bronchodilators - Alternative to oral glutocorticoids - 2-4 weeks produce beneficial effect

Question 33

Corticosteroid SE

Answer 33

- Thrush - Dysphonia (voice problems) - Adrenal suppression, cataracts

Question 34

Budesonide

Answer 34

First nebulized corticosteroid

Question 35

PO steroids

Answer 35

Such as methyprednisolone can be used

Question 36

Advair

Answer 36

Purple. Combo of fluticasone, salmeterol

Question 37

Combivent

Answer 37

Orange and green. Combo of ipratropium and albuterol

Question 38

Cromolyn (Intal) and Nedocromil (Tilade)

Answer 38

- Do not influence airway tone - Inhibit degranulation of mast cells - Prevent allergy rxn

Question 39

Singulair

Answer 39

Leukotriene inhibitor Anti-inflammatory May have increased suicide rate

Question 40

Anti-IgE antibodies

Answer 40

Xolair Inhibits binding of IgE to mast cells Prescribed by allergist

Question 41

Asthma Triad (NSAID one)

Answer 41

Asthma, nasal polyps and NSAID allergy