omed pt 2 > Asthma notes > Flashcards

Asthma notes Flashcards

(243 cards)

Study These Flashcards
1
Q

• Reactive airway disease (RAD)

A

bronchial asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is asthma also known as?

A

Bronchial asthma or reactive airway disease (RAD)

Asthma is commonly referred to by these alternative names.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What type of disease is asthma?

A

Inflammatory disease of the airways

Asthma involves inflammation affecting the air passages.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which cells are involved in asthma?

A

Mast cells, neutrophils, eosinophils, T-lymphocytes, macrophages, and epithelial cells

These cells contribute to the inflammatory process in asthma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the symptoms of asthma?

A

Coughing, wheezing, breathlessness, and chest tightness

These symptoms are associated with episodes of airway obstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What causes airway obstruction in asthma?

A

Bronchospasm

Bronchospasm leads to the narrowing of the airways, causing obstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is airflow obstruction in asthma reversible?

A

Yes, usually reversible spontaneously or through pharmacologic therapy

Asthma treatment can help alleviate the obstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the two general categories of asthma classified by etiology?

A

Extrinsic (allergic, atopic) asthma and intrinsic asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is allergic or extrinsic asthma?

A

The most common form of asthma, frequently occurring in children and young adults, often with a personal and/or family history of atopic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What type of hypersensitivity is associated with extrinsic asthma?

A

Type I hypersensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What mediates the pathogenesis of extrinsic asthma?

A

The interaction of various external allergens, sensitized IgE antibodies, and proinflammatory mast cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List common allergens associated with asthma.

A
  • Grasses
  • Pollens
  • Molds
  • Animal danders (e.g., cats, dogs)
  • Feather pillows
  • House dust mites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What happens when allergens bind to sensitized IgE on mast cells?

A

Triggers degranulation and release of histamines, bradykinins, leukotrienes, and prostaglandin D2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the consequences of the inflammatory reaction in extrinsic asthma?

A
  • Bronchospasm (contraction of airway smooth muscle)
  • Edema of airway mucosa
  • Increased mucus secretion
  • Plugging of small airways
  • Injury and desquamation of airway epithelium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

True or False: Extrinsic asthma is primarily caused by genetic factors.

A

False

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Fill in the blank: Allergic asthma is a manifestation of _______ localized to the airways.

A

type I hypersensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is intrinsic asthma?

A

Intrinsic asthma is usually not associated with a history of allergy and personal and family histories are usually negative for atopic diseases.

It typically appears first during adulthood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When does intrinsic asthma typically appear?

A

Intrinsic asthma typically appears first during adulthood.

Its onset is frequently associated with upper respiratory viral infections.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What types of viral infections are associated with the onset of intrinsic asthma?

A

Upper respiratory viral infections, such as rhinovirus and parainfluenza virus.

These infections can trigger the onset of intrinsic asthma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the etiology of intrinsic asthma?

A

The etiology of intrinsic asthma is not well understood.

It may involve a hyperirritable state of the tracheobronchial tree.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How can the central nervous system affect airway function in intrinsic asthma?

A

The central nervous system can affect airway function and tone by way of parasympathetic vagal efferent activity.

This can influence the symptoms and severity of asthma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What has been proposed as a cause of intrinsic asthma?

A

Intrinsic asthma may be the result of a hyperirritable state of the tracheobronchial tree due to:
* Defective functioning or blockade of beta-adrenergic receptors
* Excessive cholinergic activity

These factors can contribute to the airway’s responsiveness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is exercise-induced asthma?

A

Bronchospasm occurs 5 to 10 minutes after the start of physical activity due to heat loss and/or water loss from the bronchial surface

Hyperventilation of cold, dry air and emotional stress can also trigger an asthma attack.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can trigger occupational or environmental asthma?

A

Exposure to agents in the workplace or environment such as:
* B Fumes (epoxy resins, plastics)
* Organic and chemical dusts (wood, cotton, platinum)
* Chemicals (toluene diisocyanate [TDI])
* Air pollutants (ozone, sulfur dioxide, nitrogen dioxide)

These agents can act as respiratory irritants.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is drug-induced asthma (triad asthma)?
A combination of bronchospasm, sensitivity to aspirin (and some NSAIDs), beta-blockers, sulfites, and certain foods and beverages, along with rhinitis, nasal polyps, and urticaria ## Footnote Occurs in about 10% of asthma patients.
26
When does an asthmatic episode typically occur after drug ingestion in drug-induced asthma?
Approximately 20 minutes to 3 hours after ingestion of the drug ## Footnote This is not usually a true allergic hypersensitivity reaction.
27
What mechanisms are involved in drug-induced asthma?
Poorly understood pseudoallergic mechanisms including: * Altered sensitivity to leukotrienes * Abnormal release of cytotoxic compounds from platelets provoking bronchoconstriction ## Footnote This suggests a complex interaction rather than a classic allergic response.
28
What are the general signs and symptoms of an asthmatic episode?
Wheezing, dyspnea, coughing, tightness in the chest, and excess sputum production. ## Footnote Symptoms can vary with severity.
29
What physical position do patients often adopt during severe asthma attacks?
Sitting upright and leaning forward ('tripoding'). ## Footnote This position indicates increased work of breathing.
30
Name some signs that may be present during more severe asthma episodes.
* Prolonged respiratory expiration * Tachypnea * Hyperresonance * Intercostal retraction * Tachycardia * Arterial hypoxemia * Respiratory acidosis ## Footnote These signs indicate the severity of the episode.
31
How does the frequency of asthma symptoms vary among patients?
Some patients have infrequent, brief attacks while others may suffer nearly continuous symptoms. ## Footnote Frequency can significantly differ from one individual to another.
32
When are asthma symptoms frequently worse?
At night, particularly between 3 AM to 4 AM. ## Footnote This is due to circadian variations in bronchomotor tone and bronchial reactivity.
33
What is status asthmaticus?
A medical emergency characterized by hypoxemia, hypercarbia, and secondary respiratory failure unresponsive to bronchodilators. ## Footnote It can be fatal if not treated promptly.
34
What is a common laboratory finding in patients with extrinsic asthma?
Elevated levels of serum IgE and positive skin tests to various allergens ## Footnote Extrinsic asthma is often associated with specific allergic triggers.
35
What does pulmonary spirometry help determine?
The presence and extent of airflow obstruction and whether it is immediately reversible ## Footnote This diagnostic test is crucial for assessing lung function.
36
What does FEV1 stand for?
Forced Expiratory Volume in one second ## Footnote It measures the volume of air expired during the first second of forced expiration.
37
What is the definition of Forced Vital Capacity (FVC)?
The total volume of air exhaled forcefully and rapidly after maximum inhalation ## Footnote FVC is an important measurement in spirometry.
38
What spirometry findings are characteristic of airway obstruction during asthmatic episodes?
Decreased FEV1, FVC, FEV1/FVC ratio, and Peak Expiratory Flow (PEF) ## Footnote These findings indicate impaired lung function during asthma attacks.
39
What defines significant reversibility of airflow obstruction?
An increase of 12% or more and 200 mL in FEV1 or FVC after inhaling a bronchodilator ## Footnote This response is indicative of asthma and can confirm the diagnosis.
40
Does a lack of responsiveness in the pulmonary function laboratory exclude the possibility of successful bronchodilator therapy?
No ## Footnote A lack of responsiveness does not preclude success in a clinical trial of bronchodilator therapy.
41
What type of testing may be useful for patients with exercise-induced bronchospasm?
Exercise challenge testing ## Footnote This test helps to evaluate exercise-induced symptoms in asthma patients.
42
What is Peak Expiratory Flow (PEF)?
A measure of how fast air can be expelled from the lungs
43
How can PEF be measured?
Using a peak flow meter or a small inexpensive gauge
44
What is the purpose of home PEF monitoring?
To document variability of airflow obstruction and guide changes in therapy
45
Why is home PEF recording fundamental to asthma self-management?
PEF recordings are used to guide changes in therapy and initiate steroid therapy
46
When are home PEF recordings particularly useful?
* If the diagnosis of asthma is in doubt * For patients with unpredictable or frequent exacerbations * To assess response to changes in therapy
47
True or False: PEF recordings can help assess the response to therapy changes.
True
48
Fill in the blank: Home PEF recording is useful for documenting the variability of _______.
[airflow obstruction]
49
What factors do predicted values for PEF vary with?
Age, height, and gender ## Footnote Predicted values for PEF are poorly standardized.
50
Is comparison with reference values or the patient’s own baseline more helpful for PEF?
The patient’s own baseline ## Footnote Comparison with reference values is less helpful.
51
When is PEF generally lowest during the day?
On first awakening ## Footnote PEF shows diurnal variation.
52
When should PEF be measured for optimal results?
In the morning before bronchodilator administration and in the afternoon after taking a bronchodilator ## Footnote This timing helps assess the effectiveness of treatment.
53
What does a 20% change in PEF values from morning to afternoon or from day to day suggest?
Inadequately controlled asthma ## Footnote This is a key indicator of asthma management.
54
What do PEF values less than 200 L/min indicate?
Severe airflow obstruction ## Footnote This threshold is important for assessing the severity of asthma.
55
What is the normal FEV1 value range for adults?
4.0 - 6.0 L ## Footnote This range is applicable for adults without airway obstruction.
56
What is the normal FEV1/FVC percentage in adults?
80 - 90% ## Footnote This percentage indicates the proportion of a person's vital capacity that they can forcibly exhale in one second.
57
What is the normal peak expiratory flow (PEF) range for males?
550 - 650 L/min ## Footnote PEF values can vary based on height, sex, and altitude.
58
What is the normal peak expiratory flow (PEF) range for females?
400 - 500 L/min ## Footnote PEF values may differ due to factors such as height and sex.
59
What FEV1 value indicates mild airway obstruction?
3.0 L ## Footnote Mild obstruction is characterized by a decrease in FEV1 but still within a manageable range.
60
What is the FEV1/FVC percentage for mild airway obstruction?
70% ## Footnote This indicates a reduced ability to expel air from the lungs compared to normal values.
61
What is the peak expiratory flow (PEF) range for mild airway obstruction?
300 - 400 L/min ## Footnote This range reflects a decreased airflow but not critically low.
62
What FEV1 value indicates moderate airway obstruction?
1.6 L ## Footnote Moderate obstruction shows a significant decline in lung function.
63
What is the FEV1/FVC percentage for moderate airway obstruction?
50% ## Footnote This indicates a more severe reduction in air expulsion capability.
64
What is the peak expiratory flow (PEF) range for moderate airway obstruction?
200 - 300 L/min ## Footnote This indicates further decline in airflow compared to mild obstruction.
65
What FEV1 value indicates severe airway obstruction?
0.6 L ## Footnote Severe obstruction presents a critical reduction in lung capacity.
66
What is the FEV1/FVC percentage for severe airway obstruction?
40% ## Footnote This reflects a dangerously low ability to expel air from the lungs.
67
What is the peak expiratory flow (PEF) for severe airway obstruction?
< 200 L/min ## Footnote This indicates a severely compromised ability to exhale air.
68
True or False: Peak flow and spirometry values are unaffected by height and sex.
False ## Footnote These values can vary significantly based on height, sex, and altitude.
69
Fill in the blank: The reduced barometric pressures found at higher elevations ______ airflow.
increase ## Footnote Higher elevations can enhance airflow due to lower atmospheric pressure.
70
What is the purpose of the asthma classification schemes developed by the Expert Panel of the National Asthma Education and Prevention Program?
To direct asthma therapy and identify patients at high risk of developing life-threatening asthma attacks ## Footnote These schemes are essential for managing asthma effectively.
71
What type of questions are outlined in Table 2 for assessing asthma severity?
General questions used in assessing and monitoring the severity of a patient’s asthma symptoms ## Footnote These questions help healthcare providers evaluate the patient's condition.
72
What is the purpose of Figure 1 from the Expert Panel Report 3 (EPR-3) regarding asthma?
To classify the severity of asthma in a patient not currently receiving long-term control medications ## Footnote This classification is based on clinical features before treatment.
73
What does Figure 2 from the Expert Panel Report 3 (EPR-3) classify?
The severity of asthma exacerbations ## Footnote Understanding exacerbation severity is crucial for timely intervention.
74
How is a patient's asthma severity classified using Figure 1?
Based on the presence of clinical features before treatment ## Footnote Only one severity feature is needed to categorize the patient.
75
When assigning a patient to a severity category, what should be considered?
Patients should be assigned to the most severe grade in which any feature occurs ## Footnote This ensures that the patient's condition is accurately reflected.
76
What symptoms are assessed for severity of asthma?
Chest tightness, cough, shortness of breath, wheezing ## Footnote Symptoms are evaluated based on their frequency and impact on daily life.
77
How many days in the past week have you had chest tightness, cough, shortness of breath, or wheezing?
____ days ## Footnote This question helps to quantify the frequency of asthma symptoms.
78
How many nights have you awakened due to asthma symptoms?
____ nights ## Footnote Nighttime symptoms can indicate poor asthma control.
79
How many mornings have you awakened with asthma symptoms?
____ mornings ## Footnote Morning symptoms can suggest ongoing airway inflammation.
80
How many times did asthma symptoms not improve within 15 minutes of using a bronchodilator?
____ times ## Footnote This indicates the effectiveness of rescue medication.
81
How has asthma restricted your physical activity?
____ days ## Footnote Assessing activity limitation helps evaluate control of asthma.
82
How many days have you missed from work/school due to asthma?
____ days ## Footnote Absenteeism can reflect the impact of asthma on daily functioning.
83
How many times have you had asthma symptoms while exercising or playing?
____ times ## Footnote Exercise-induced symptoms are common in asthma patients.
84
Have you had any unscheduled visits to a doctor due to asthma?
Yes / No ## Footnote Unscheduled visits may indicate worsening asthma control.
85
What is the highest peak expiratory flow (PEF) since your last visit?
Highest: ________ ## Footnote PEF is a measure of lung function in asthma management.
86
What is the lowest peak expiratory flow (PEF) since your last visit?
Lowest: ________ ## Footnote Monitoring PEF helps assess the severity of airflow obstruction.
87
Has your PEF dropped below x L/min since your last visit?
Yes / No ## Footnote x = 80% of the patient’s personal best PEF indicates a significant decline in lung function.
88
What does the Asthma Control Test (ACT) consist of?
A 5-item questionnaire ## Footnote The ACT is a patient-based tool for identifying poorly controlled asthma.
89
How is the reliability of the ACT described?
Reliable, valid, and responsive to changes in asthma control over time ## Footnote According to Schatz M, et al. J Allergy Clin Immunol. 2006 Mar;117(3):549-56.
90
What is the range of possible scores on the ACT?
5 to 25 points ## Footnote A score of 5 indicates uncontrolled asthma, while 25 indicates well-controlled asthma.
91
What cutoff score on the ACT identifies inadequately controlled asthma?
19 points or less ## Footnote Patients scoring 19 or less are likely to benefit from reassessment of their treatment regimen.
92
In what setting is the ACT particularly useful?
Clinical setting ## Footnote It helps healthcare providers identify patients with poorly controlled asthma.
93
What is the primary purpose of the ACT?
To identify patients with poorly controlled asthma ## Footnote It facilitates tracking patients' progress with treatment.
94
What is the basis for determining the level of severity for patients not currently taking long-term control medications?
Severity is determined by both impairment and risk.
95
How is the impairment domain assessed?
By patient’s/caregiver’s recall of the previous 2–4 weeks and spirometry.
96
When assigning severity, how should it be categorized?
Assign severity to the most severe category in which any feature occurs.
97
True or False: There are adequate data to correspond frequencies of exacerbations with different levels of asthma severity.
False
98
What do more frequent and intense exacerbations indicate?
Greater underlying disease severity.
99
What is an example of an exacerbation that indicates greater severity?
Exacerbations requiring urgent, unscheduled care, hospitalization, or ICU admission.
100
For treatment purposes, how should patients with > 2 exacerbations requiring oral systemic corticosteroids in the past year be considered?
They may be considered the same as patients who have persistent asthma.
101
Fill in the blank: Patients who had _______ exacerbations requiring oral systemic corticosteroids in the past year may be considered the same as patients who have persistent asthma.
> 2
102
What should be noted about impairment levels consistent with persistent asthma in relation to treatment?
They may be absent even if patients had > 2 exacerbations.
103
Classifying Severity for Patients > 12 Years of Age Who Are Not Currently Taking Long-term Control Medications
104
What are the goals of asthma therapy?
To minimize chronic symptoms, prevent recurrent exacerbations, minimize emergency visits, and maintain near-normal pulmonary function ## Footnote These goals should be achieved while providing optimal pharmacotherapy with minimal adverse effects and ensuring patient satisfaction.
105
What is one goal of asthma therapy related to physical activity?
Minimize chronic symptoms that impair normal activity, including exercise ## Footnote Chronic symptoms can limit a patient's ability to engage in everyday activities.
106
True or False: One goal of asthma therapy is to increase the need for emergency department visits.
False ## Footnote The goal is to minimize the need for emergency department visits or hospitalizations.
107
Fill in the blank: Asthma therapy aims to maintain _______ pulmonary function.
near-normal ## Footnote Maintaining near-normal pulmonary function is crucial for effective asthma management.
108
What is important to consider when providing asthma pharmacotherapy?
Providing optimal pharmacotherapy with the fewest adverse effects ## Footnote Balancing effective treatment with minimization of side effects is essential in asthma care.
109
What should asthma care meet according to patients and families?
Expectations of satisfaction with asthma care ## Footnote Patient and family satisfaction is a critical component of effective asthma management.
110
What are the goals for asthma therapy?
• Minimal or no chronic asthma symptoms, day or night. • No limitations on activities; no school/work missed because of asthma. • Minimal or no recurrent exacerbations of asthma; minimal or no emergency department visits or hospitalizations. • Minimal use of bronchodilator (short-acting beta-2-agonist) inhaler (< 1 time per day; < 1 canister per month). • Normal or near-normal lung function. • Minimal or no adverse side-effects from medications. ## Footnote These goals are essential for effective asthma management.
111
What is considered minimal use of a bronchodilator inhaler for asthma therapy?
< 1 time per day; < 1 canister per month. ## Footnote This indicates effective control of asthma symptoms.
112
What should be the status of lung function in asthma therapy?
Normal or near-normal lung function. ## Footnote Maintaining good lung function is crucial for overall health and quality of life.
113
True or False: One of the goals of asthma therapy is to have recurrent exacerbations of asthma.
False. ## Footnote Goals include minimal or no recurrent exacerbations.
114
What are the desired outcomes regarding asthma symptoms according to asthma therapy goals?
Minimal or no chronic asthma symptoms, day or night. ## Footnote This is vital for daily functioning and well-being.
115
What is a key goal regarding activities for individuals receiving asthma therapy?
No limitations on activities; no school/work missed because of asthma. ## Footnote This ensures that asthma does not adversely affect quality of life.
116
What should be the frequency of emergency department visits or hospitalizations for asthma management?
Minimal or no emergency department visits or hospitalizations. ## Footnote This reflects effective asthma control.
117
What is one of the goals of asthma therapy concerning medication side effects?
Minimal or no adverse side-effects from medications. ## Footnote Patients should manage asthma effectively without significant medication-related issues.
118
What are the two categories of asthma medications?
Quick-relief (rescue/reliever) medications and long-term control (controller) medications ## Footnote Quick-relief medications help in immediate symptom relief, while long-term control medications manage airway inflammation.
119
What is the primary action of quick-relief asthma medications?
Direct relaxation of bronchial smooth muscle ## Footnote This action helps in promptly reversing acute airflow obstruction.
120
What do long-term control asthma medications primarily target?
Airway inflammation ## Footnote These medications are taken daily, regardless of symptoms, to control persistent asthma.
121
How are most asthma medications administered?
Orally or by inhalation ## Footnote Inhalation route offers a more rapid onset of pulmonary effects.
122
What are the advantages of inhalation over oral administration of asthma medications?
More rapid onset of pulmonary effects and fewer systemic effects ## Footnote This makes inhalation a preferred method for asthma treatment.
123
What technique can improve drug delivery to the lung when using metered-dose inhalers (MDIs)?
Proper inhaler technique and the use of an inhalation chamber (spacer) ## Footnote These methods help decrease oropharyngeal deposition.
124
Who is nebulizer therapy reserved for?
Acutely ill patients and those who cannot use inhalers ## Footnote This includes patients with difficulties in coordination, understanding, or cooperation.
125
What is asthma usually managed with?
Pharmacological treatments
126
What are the categories of drugs used for asthma management?
1. Quick-relief (rescue/reliever) medications 2. Long-term control medications
127
What are quick-relief medications also known as?
Rescue or reliever medications
128
What type of bronchodilators are used as quick-relief medications?
Short-acting inhaled sympathomimetic (beta-2-selective agonist) bronchodilators (SABA)
129
Name two examples of SABA medications that act for less than 3 hours.
* Epinephrine * Isoproterenol
130
Name examples of SABA medications that act for 3 to 6 hours.
* Albuterol * Bitolterol * Fenoterol * Metaproterenol * Pirbuterol * Terbutaline
131
How are SABA medications typically administered?
In a metered-dose inhaler
132
What is the primary use of quick-relief medications?
Treatment (relief) of acute bronchospasm
133
What is Airsupra?
A metered-dose inhaler that combines albuterol (SABA) and budesonide (localized corticosteroid) ## Footnote Used for the treatment of acute bronchospasm and prevention of bronchoconstriction in adult patients with asthma.
134
What is the primary use of albuterol in Airsupra?
Treatment of acute bronchospasm ## Footnote Albuterol is a short-acting beta-agonist (SABA).
135
What role does budesonide play in Airsupra?
Localized corticosteroid for reducing the risk of exacerbations ## Footnote Budesonide helps in managing inflammation in asthma patients.
136
What type of inhaler is Airsupra?
Metered-dose inhaler ## Footnote This type of inhaler delivers a specific amount of medication with each puff.
137
Who is Airsupra indicated for?
Adult patients with asthma ## Footnote Specifically for those needing treatment for bronchospasm and prevention of bronchoconstriction.
138
Fill in the blank: Airsupra is used to _______ the risk of exacerbations in asthma patients.
reduce
139
True or False: Airsupra can be used for the prevention of bronchoconstriction.
True
140
What are the localized corticosteroids used for asthma control?
Beclomethasone, budesonide, triamcinolone, ciclesonide, flunisolide, fluticasone, mometasone ## Footnote These corticosteroids are administered via a metered-dose inhaler and are preferred first-line agents for persistent asthma.
141
What is the primary benefit of inhaled corticosteroids (ICS) in asthma management?
Reduce both acute and chronic inflammation, improve airflow, decrease airway hyper-responsiveness, and reduce asthma exacerbations ## Footnote Maximum therapeutic responses may not be observed for months.
142
How can local side effects from inhaled corticosteroids be minimized?
Using an inhalation chamber and rinsing the mouth after use ## Footnote This reduces cough, dysphonia, oropharyngeal candidiasis, and systemic absorption.
143
When are systemic corticosteroids used in asthma treatment?
During exacerbations or when initiating long-term therapy in patients with severe symptoms ## Footnote They may be required for long-term suppression in refractory asthma.
144
What are long-acting inhaled sympathomimetic bronchodilators (LABA)?
Formoterol, salmeterol ## Footnote They are typically used in a metered-dose inhaler for prevention of acute bronchospasm.
145
What is the role of methylxanthines in asthma management?
Mild bronchodilation and anti-inflammatory effects ## Footnote Theophylline is a key methylxanthine that also enhances mucociliary clearance and strengthens diaphragmatic contractility.
146
What must be monitored closely when using theophylline?
Theophylline serum concentrations ## Footnote Due to its narrow toxic-therapeutic range and individual differences in metabolism.
147
What do mast cell stabilizers do in asthma treatment?
Modulate mast cell mediator release and eosinophil recruitment ## Footnote They inhibit early and late asthmatic responses but have no bronchodilating effects.
148
What are leukotriene receptor antagonists (LTRA)?
Montelukast sodium, zafirlukast, zileuton ## Footnote They are oral medications that inhibit cysteinyl leukotrienes and are used for long-term asthma control.
149
What pathophysiological processes are correlated with cysteinyl leukotrienes in asthma?
Airway edema, smooth muscle constriction, altered cellular activity ## Footnote These processes contribute to the signs and symptoms of asthma.
150
Fill in the blank: The maximum therapeutic responses from inhaled corticosteroids may not be observed for _______.
months
151
True or False: Mast cell stabilizers can be used to treat an acute asthmatic attack.
False ## Footnote They are ineffective for acute attacks as they do not have bronchodilating effects.
152
What is the combination of fluticasone and salmeterol known as?
Advair ## Footnote Fluticasone is an inhaled corticosteroid (ICS) and salmeterol is a long-acting beta-agonist (LABA)
153
What is the combination of budesonide and formoterol known as?
Symbicort, DuoResp ## Footnote Budesonide is an ICS and formoterol is a LABA
154
What is the combination of mometasone and formoterol known as?
Dulera ## Footnote Mometasone is an ICS and formoterol is a LABA
155
What is the combination of budesonide and salmeterol known as?
Busalair ## Footnote Budesonide is an ICS and salmeterol is a LABA
156
What type of medications do drug manufacturers offer for asthma?
Combinations of long-term asthma control medications ## Footnote These combinations are designed for convenient use by patients
157
Fill in the blank: The combination of __________ and salmeterol is known as Advair.
fluticasone
158
True or False: All medications listed are combinations of inhaled corticosteroids and long-acting beta-agonists.
True
159
What are the three key components in asthma combination therapies mentioned?
* Inhaled corticosteroids (ICS) * Long-acting beta-agonists (LABA) * Combination medications
160
What is Omalizumab (Xolair)?
A recombinant humanized monoclonal antibody directed against IgE for moderate and severe persistent asthma ## Footnote It forms complexes with free IgE, blocking its interaction with mast cells and basophils.
161
What is the primary function of Omalizumab?
To prevent the degranulation of mast cells and basophils by blocking IgE interaction ## Footnote This is important for patients with elevated IgE levels who are refractory to other treatments.
162
What is Mepolizumab (Nucala) used for?
An add-on treatment for severe asthma in patients ≥ 12 years old with blood eosinophil counts of 150/μL or greater ## Footnote It is indicated for patients who are uncontrolled on Step 4 treatment.
163
What type of antibody is Mepolizumab?
Monoclonal antibody to IL-5 ## Footnote It targets interleukin-5 to reduce eosinophil levels.
164
What distinguishes Reslizumab (Cinqair) from Mepolizumab?
Reslizumab requires a higher eosinophil cutoff of 400/μL or greater ## Footnote Both are anti-IL-5 monoclonal antibodies for severe eosinophilic asthma.
165
What is Dupilumab (Dupixent) approved for?
Moderate to severe asthma in patients > 12 years old with eosinophilic phenotype or corticosteroid-dependent asthma ## Footnote It is a human monoclonal antibody to IL-4 and IL-13.
166
What is the mechanism of action of Dupilumab?
It inhibits IL-4 and IL-13 signaling ## Footnote This action helps in managing asthma symptoms by targeting specific inflammatory pathways.
167
What is Benralizumab (Fasenra)?
A monoclonal anti-IL5 receptor alpha antibody ## Footnote It is an FDA-approved add-on treatment for persistent severe eosinophilic asthma in patients > 12 years old.
168
What is the target population for Benralizumab?
Patients > 12 years old with persistent severe eosinophilic asthma ## Footnote It is used as an additional treatment option.
169
What are indications suggesting inadequate treatment in a patient with asthma?
Symptoms 2 or more days per week, use of a SABA more than 2 days per week, increased respiratory rate (> 50% above normal), FEV1 that has fallen more than 10% or to below 80% of peak FEV1, eosinophil count above 50/mm3, poor drug use compliance, one or more ED visits within the previous 3 months ## Footnote These indicators help assess the control of asthma in patients.
170
What does the use of more than 1.5 canisters of a SABA inhaler per month indicate?
High risk for a severe asthma attack ## Footnote This corresponds to more than 200 inhalations per month.
171
How much more likely are patients with asthma to have gastroesophageal reflux disease (GERD)?
3 times more likely ## Footnote This association highlights the comorbidity between asthma and GERD.
172
What effect does the presence of acid in the distal esophagus have on asthma?
It can significantly increase airway resistance and airway reactivity ## Footnote This is mediated via vagal or other neural reflexes.
173
What therapy may improve asthma symptoms and pulmonary function in selected patients?
Aggressive antireflux therapy ## Footnote This may be particularly relevant for patients with concurrent GERD.
174
What types of medications may improve asthma symptoms or unexplained chronic cough?
* Proton pump inhibitors * H2 blockers ## Footnote These medications can help manage symptoms related to GERD in asthmatic patients.
175
Fill in the blank: Symptoms occurring _____ or more days per week suggest inadequate treatment in asthma.
2 ## Footnote This is one of the key indicators of poor asthma control.
176
True or False: A FEV1 that has fallen to below 80% of peak FEV1 indicates good asthma control.
False ## Footnote A significant drop in FEV1 is a marker of inadequate asthma control.
177
What is bronchial thermoplasty (BT)?
A novel intervention for asthma using controlled radiofrequency thermal energy delivered to the airway wall during bronchoscopy procedures ## Footnote The Alair® System, approved by the FDA in 2010, is used in this treatment.
178
How many bronchoscopy procedures are involved in bronchial thermoplasty?
Three procedures ## Footnote One for each lower lobe and one for both upper lobes.
179
What is the duration between each bronchial thermoplasty session?
Three weeks
180
What temperature is targeted during bronchial thermoplasty?
65°C
181
What is the effect of bronchial thermoplasty on airway tissue?
Acute airway tissue destruction with regeneration observed in the epithelium, blood vessels, mucosa, and nerves
182
What component of the airway shows almost no capacity for regeneration after bronchial thermoplasty?
Airway smooth muscle
183
What replaces airway smooth muscle that has been destroyed during bronchial thermoplasty?
Connective tissue
184
True or False: Bronchial thermoplasty involves a single session of treatment.
False
185
Fill in the blank: Bronchial thermoplasty delivers controlled _______ thermal energy to the airway wall.
radiofrequency
186
What is the main goal of bronchial thermoplasty in asthma management?
To reduce airway constriction during asthma attacks
187
Stepwise Approach for Managing Asthma in Youths > 12 Yr and Adults
188
Assessing Asthma Control in Children >12 Years of Age and Adults
189
What are common complications of asthma?
Exhaustion, dehydration, airway infection, cor pulmonale, tussive syncope, status asthmaticus ## Footnote Status asthmaticus is characterized by small airway obstruction that is refractory to sympathomimetic and anti-inflammatory agents and may progress to respiratory failure without prompt intervention.
190
What is status asthmaticus?
Small airway obstruction that is refractory to sympathomimetic and anti-inflammatory agents ## Footnote It may progress to respiratory failure without prompt and aggressive intervention.
191
What can occur in severe asthma?
Acute hypercapnic and hypoxic respiratory failure ## Footnote This highlights the potential severity of asthma complications.
192
Fill in the blank: Complications of asthma may include _______.
exhaustion, dehydration, airway infection, cor pulmonale, tussive syncope, status asthmaticus
193
What specific oral condition is related to the use of inhaled beta-2-selective agonists?
Xerostomia ## Footnote Xerostomia refers to dry mouth, which can result from asthma medications.
194
What oral health issues can arise from the use of inhaled corticosteroids?
Increased caries and oral pharyngeal candidiasis ## Footnote Oral pharyngeal candidiasis is a fungal infection that can occur due to dry mouth.
195
What is a potential direct effect of asthma medications on oral health?
Soreness of the oral mucosa ## Footnote This soreness can result from irritation caused by the medications.
196
What device can be used with metered dose inhalers to help prevent oral mucosal disorders?
Aerosol holding chambers (spacers) ## Footnote Spacers help in better medication delivery and reduce side effects on oral tissues.
197
What practice can help prevent oral mucosal disorders after using asthma medications?
Mouth rinsing after medication usage ## Footnote Rinsing helps to remove medication residues that might irritate the oral cavity.
198
What is the first step in the dental evaluation of a patient with a history of asthma?
Determine the patient's medical history.
199
What specific information is needed regarding the age of asthma onset?
Age of asthma onset.
200
What types of asthma should be identified during the evaluation?
Intrinsic versus extrinsic.
201
What are some common precipitating factors for asthma?
* Pollens * Dusts * Odors * Exercise * Stress * Drugs (especially aspirin and NSAIDs)
202
What should be assessed regarding medications during the dental evaluation?
Medications currently taken to control asthma.
203
What classification is used to assess asthma severity?
Classification of asthma severity.
204
What is assessed to determine the current adequacy of medical control of asthma?
General questions used for assessing adequacy.
205
What type of medications should be considered when assessing adequacy of asthma control?
Long-term control medications.
206
What vital signs should be checked during a physical and dental exam?
Blood pressure and pulse ## Footnote Elevated blood pressure, tachycardia, or irregular pulse rhythm may indicate toxic reactions or overdose.
207
What symptoms may indicate toxicity or overdose of sympathomimetic or anticholinergic bronchodilators?
* Anxiety * Tremors * Palpitations * Dizziness * Nausea * Vomiting ## Footnote These symptoms are important for identifying potential drug-related issues.
208
What are the potential oral health issues associated with systemic and inhaled corticosteroids?
Oral candidiasis ## Footnote Corticosteroids can predispose patients to this fungal infection.
209
What condition may be caused by anticholinergics, methylxanthines, and sympathomimetic bronchodilators?
Xerostomia ## Footnote This refers to dry mouth, which can lead to various oral health problems.
210
True or False: Tachycardia may be a sign of overdose of methylxanthines.
True ## Footnote Tachycardia is one of the symptoms indicating potential toxicity.
211
Fill in the blank: Elevated blood pressure, ________, or irregular pulse rhythm may indicate toxic reactions.
tachycardia ## Footnote Monitoring these vital signs is crucial for patient safety.
212
What are the signs to check for intraorally during a dental exam?
* Candidiasis * Xerostomia ## Footnote These signs relate to the effects of certain medications on oral health.
213
When is a medical consult indicated for asthma patients?
For patients with 'not well controlled' or 'very poorly controlled' asthma or scoring 19 points or less on the Asthma Control Test (ACT) ## Footnote Refer to Figure 4 for definitions of asthma control categories.
214
What should be advised to the physician regarding asthma patients?
The signs and symptoms indicative of poorly controlled (or uncontrolled) asthma ## Footnote This information is crucial for effective management and treatment adjustments.
215
What does ASA stand for in the context of asthma classification?
American Society of Anesthesiologists
216
What is the ACT score for mild intermittent or mild persistent asthma that is well controlled?
ACT ≥ 20
217
List the criteria for mild intermittent or mild persistent asthma.
* Asthma symptoms on 2 or less days per week * Two or less nighttime awakenings per month due to asthma symptoms * No interference with or limitation of normal daily activities due to asthma * Use of a short-acting beta-2-selective agonist inhaler on 2 or less days per week due to acute asthma symptoms * PEF or FEV1 greater than 80% personal best or % predicted
218
What defines a patient with stress/anxiety-induced asthma attacks?
Asthma that is not well controlled with ACT 16 to 19
219
What are the symptoms indicating asthma that is not well controlled?
* Asthma symptoms more than 2 days per week * One to three nighttime awakenings per week due to asthma symptoms * Some interference with / limitation of normal daily activities due to asthma * Use of a short-acting beta-2-selective agonist inhaler more than 2 times per day due to acute asthma symptoms * PEF or FEV1 60% to 80% personal best or % predicted
220
What indicates very poorly controlled or uncontrolled asthma?
ACT ≤ 15
221
What are the criteria for very poorly controlled or uncontrolled asthma?
* Asthma symptoms occurring throughout the day * Four or more nighttime awakenings per week due to asthma symptoms * Very significant interference with / limitation of normal daily activities due to asthma * Use of a short-acting beta-2-selective agonist inhaler several times per day due to acute asthma symptoms * PEF or FEV1 less than 60% personal best or % predicted
222
What should be done for patients classified as ASA IV?
Refer to physician for evaluation of adequacy of control of asthma
223
Fill in the blank: A patient with an ACT score of _______ is considered to have very poorly controlled asthma.
15
224
What should a patient with asthma bring to each dental appointment?
Their short-acting bronchodilator inhaler (e.g., albuterol) ## Footnote This is important for immediate access during treatment.
225
Why is it beneficial for asthma patients to use their inhaler prior to dental treatment?
It may help prevent stress-induced asthma attacks ## Footnote Prophylactic use can enhance patient comfort.
226
What known precipitating factor should be avoided for asthma patients during dental treatment?
Contact with any known triggers, such as vapors from methyl methacrylate monomer ## Footnote These vapors can cause asthma attacks in sensitive individuals.
227
What premedication may be indicated for patients whose asthma is triggered by anxiety or stress?
Benzodiazepine and/or nitrous oxide-oxygen inhalation sedation ## Footnote This can help manage anxiety and prevent asthma attacks.
228
Is nitrous oxide-oxygen inhalation sedation safe for all asthma patients?
No, it is usually contraindicated in patients with severe asthma ## Footnote Severe asthma may react adversely due to nitrous oxide's irritant effects.
229
When should a consultation with the patient's physician be considered?
Before using nitrous oxide in patients with severe asthma ## Footnote This ensures safety and appropriateness of sedation.
230
True or False: Nitrous oxide-oxygen inhalation sedation can be used safely in patients with mild to moderate asthma.
True ## Footnote It is generally effective for these patients.
231
What should be avoided in patients with a history of asthma induced by NSAIDs?
Aspirin or NSAIDs ## Footnote This includes patients with NSAID-exacerbated respiratory disease (N-ERD) or those with asthma and nasal polyps.
232
Which opioids should be avoided in patients with a history of asthma exacerbation?
Morphine and meperidine ## Footnote These opioids can trigger asthma exacerbations by releasing proinflammatory mediators.
233
What is contraindicated in patients with known sulfite sensitivity?
Local anesthetics containing vasoconstrictors ## Footnote This is especially true for severe asthmatics dependent on systemic steroids.
234
What is the risk for patients taking systemic corticosteroids for asthma?
Adrenal suppression and immunosuppression ## Footnote Evaluation is needed prior to invasive dental treatment to consider supplemental corticosteroids.
235
What is the normal oxygen saturation (SaO2) range for patients breathing room air?
97% to 100% ## Footnote A drop below 91% indicates impaired oxygen exchange.
236
What can macrolide antibiotics like erythromycin or clarithromycin cause?
Elevated serum methylxanthine (theophylline) levels ## Footnote This may lead to toxicity.
237
Are there any specific contraindications to the use of a rubber dam in asthma patients?
No specific contraindications ## Footnote Rubber dams can be used safely in patients with a history of asthma.
238
Fill in the blank: Patients with asthma and a history of angioedema should avoid _______.
NSAIDs ## Footnote This is due to the increased risk for an NSAID-induced acute asthma exacerbation.
239
What should be monitored during dental treatment to assess respiratory status?
Oxygen saturation (SaO2) ## Footnote This helps determine the need for intervention if levels drop.
240
True or False: Opioids can cause respiratory depression in patients with severe asthma.
True ## Footnote This is due to their respiratory depressant effects.
241
what step pt will have oral systemic corticosteroid
step 6
242
98 % of asthma pts are okay to use nitrous oxide on them except patients with intrinsic asthma , its contraindicated. T/F
true
243
no contraindication for the use of rubber dam on patients with Asthma
true
omed pt 2
flashcards
Decks in class (40)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions