Asthma

Question 1

does asthma primarily affect children or adults?

Answer 1

children (10%)

Question 2

what percent of adults have asthma?

Answer 2

6%

Question 3

what is the life of the disease?

Answer 3

• many cases spontaneously resolve after puberty

- progress to COPD

Question 4

asthma

Answer 4

• inflammatory airway disease with an exaggerated contractile response
• secondary to variety of stimuli

Question 5

how is asthma characterized?

Answer 5

REVERSIBLE episodes of hyperresponsiveness

• difficulty breathing
• coughing
• wheezing

Question 6

pathophysiology of asthma

Answer 6

• contraction of airway smooth m.
• thickening of airway wall secondary to inflammatory response
• plugging of airway with mucous

Question 7

asthma pts experience decreased airway diameter + increased airway resistance =

Answer 7

difficulty with EXPIRATION

Question 8

etiology of asthma

Answer 8

environment + genetic susceptibility

Question 9

unavoidable triggers of asthma

Answer 9

• respiratory tract illnessess
• physical exertion
• hormonal fluctuations
• extreme emotion

Question 10

asthma triggers that can be addressed/treated

Answer 10

• inhaled allergens
• respiratory irritants
• comorbid conditions
• medications
• influenza
• pneumococcal infection
• dietary sulfites

Question 11

Aspirin and NSAIDS will exacerbate symptoms in what percentage of asthmatic pts?

Answer 11

3-5%

Question 12

medical management of asthmatic pts

Answer 12

• routine management of syms and lung fxn
• pt education
• control environmental factors and comorbid conditions that contribute to asthma severity
• pharmacologic therapy

Question 13

goals of medical management of asthmatic pts

Answer 13

• reduce impairment

- reduce risk

Question 14

what is considered reduce impairment of asthmatic pts?

Answer 14

• freedom from frequent syms
• minimal need (≤2d/wk) of inhaled short-acting beta agonists to relieve syms
• maintenance of normal daily activities, including athletics and exercise

Question 15

why do you want to reduce risk of asthmatic pts?

Answer 15

• prevent recurrent exacerbations and ED care

- optimization of pharmacotherapy with minimal or no adverse effects

Question 16

pharmacologic management of intermittent asthmatic pts

Answer 16

inhaled quick-acting beta-2 agonists prn

Question 17

what is the most common asthma inhaler?

Answer 17

Albuterol - has least CV effects

Question 18

pharmacologic management of persistent asthmatic pts

Answer 18

• inhaled glucocorticoids scheduled

- inhaled quick-acting beta-2 agonists prn

Question 19

can inhaled glucocorticoids be used in emergencies?

Answer 19

no, they’re slow acting - takes a couple of hours to take effect

Question 20

inhaled glucocorticoids

Answer 20

steroid that decreases inflammation within airway

Question 21

additional drugs that asthmatic pts can be prescribed?

Answer 21

• leukotriene inhibitors

- inhaled long-acting beta-2 agonists

Question 22

character of well-controlled asthma

Answer 22

• daytime syms no more than 2x/month
• nighttime syms no more than 2x/month
• short acting B agonists for relief of asthma symptoms needed <3d/wk
• no interference w normal activity
• oral steroids courses and/or urgent care visits no more than 1x/yr

Question 23

character of severe disease

Answer 23

• frequent exacerbations
• exercise intolerance
• multiple scheduled meds
• ED visits

Question 24

assessment of risk factors for future exacerbations

Answer 24

• oral glucocorticoids for asthma in last yr
• hospitalized in last yr
• admitted to intensive care or intubated within past 5 yrs
• current cig smoker
• increase in asthma syms after taking Aspirin or NSAIDS

Question 25

asthmatic pt that are not a candidate for elective care

Answer 25

- current syms such as SOB, wheezing, increased respiratory rate - +/- poor compliance with drug therapy - ED visit within last 3 months

Question 26

mods to dental care

Answer 26

- remind pts to take regularly scheduled meds and bring emergency inhaler with them - stress/anxiety management, N2O sedation - avoid Aspirin/NSAIDS

Question 27

arachidonic acid produces which enzymes

Answer 27

- lipoxygenase | - cyclooxygenase (COX-1 and COX-2)

Question 28

leukotrienes trigger what?

Answer 28

anaphylactoid syndromes

Question 29

COX-1 acts on what?

Answer 29

- prostaglandins | - thromboxane A2

Question 30

COX-2 acts on what?

Answer 30

- prostaglandins | - prostacyclin

Question 31

role of prostaglandins (COX-1)

Answer 31

- gastric mucosal barrier | - renal fxn

Question 32

role of thromboxane A2

Answer 32

- platelet aggregation | - vasoconstriction

Question 33

role of prostaglandins (COX-2)

Answer 33

- pain, inflammation, fever | - renal fxn

Question 34

role of prostacyclin

Answer 34

- platelet inhibition | - vasodilation

Question 35

Aspirin and NSAIDS block which enzyme?

Answer 35

cyclooxygenases (COX-1 and COX-2)

Question 36

syms of asthma attack

Answer 36

- breathlessness - wheezing - cough - chest tightness

Question 37

asthma attack

Answer 37

- sudden onset with peak syms after 10-15 mins | - typically self-limiting

Question 38

treatment of asthma attack

Answer 38

- inhaled short-acting beta-2 agonists - 2-8 puffs, repeat Q20 mins - supportive care via O2 and vitals - activate EMS prn

Question 39

what is used to treat acute broncospasm

Answer 39

- beta-2 adrenergic agonist, albuterol

Question 40

status asthmaticus

Answer 40

- severe, prolonged asthma attack (>24 hrs) - can lead to exhaustion, dehydration, peripheral vascular collapse, death - true medical emergency

Question 41

status asthmaticus is associated with what?

Answer 41

respiratory infection

Question 42

T/F: pts with asthma have no issue getting O2 in but have a problem getting rid of CO2?

Answer 42

true