Lecture 7: Asthma

Question 1

Asthma is characterized by a limitation of airflow on which clinical tests?

Answer 1

• PFT

or

• Positive bronch-provocation challenge (i.e., methacholine challenge)

Question 2

What are the walls of the airway like in an asthmatic and what occurs to the airway during an asthmatic attack?

Answer 2

• Walls = inflammed and thickened
• During attack = tightened smooth ms.

Question 3

What is the strongest predisposing factor to asthma?

Answer 3

Atopy

Question 4

What is difference in terms of airflow limitation reversibility in asthma vs. COPD?

Answer 4

• Asthma = reversible
• COPD = partially reversible; may be irreversible w/ significant disease

Question 5

What time of the day do sx’s of asthma typically worsen?

Answer 5

Occur/worsen at night (often awaken pt)

Question 6

What is this flow-volume curve indicative of?

Answer 6

Vocal cord dysfunctions

Question 7

What is this flow-volume curve indicative of?

Answer 7

Asthma

Question 8

What do the curves of A-C represent?

Answer 8

A) Normal

B) Obstructive (i.e., asthma or COPD)

C) Restrictive

Question 9

What are 2 classes of drugs which are great for long-term control of asthma?

Answer 9

• Inhaled corticosteroids
• Leukotriene modifiers (i.e., montelukast, zafirlukast, zileuton)

Question 10

Which RR and HR is a sign of imminent respiratory arrest?

Answer 10

• RR = >30/minute
• HR = bradycardia

Question 11

What are the criteria for days per week w/ sx’s, nighttime awakenings, use of SABA for sx control, and interference with normal activity for asthma to be classfied as intermittent?

Answer 11

• Sx’s = ≤2 days/week
• Nighttime awakenings = ≤2x/month
• Use of SABA for sx’s = ≤2 days/week
• NO interference w/ normal activity

Question 12

Moving from the intermittent category of asthma to the persistent category is an indication for the use of what?

Answer 12

Long-term preventative medicine such as ICS

Question 13

How many exacerbations of a pt’s asthma requiring oral systemic corticosteroids per year places them in the intermittent vs. persistent classification?

Answer 13

• 0-1/year = intermittent
• ≥2/year = persistent

Question 14

Pts who had ≥2 exacerbations requiring oral systemic glucocorticoids in the past year may be considered the same as patients who have what classification of asthma; even in the absence of what?

Answer 14

Persistent asthma.. even in the absence of impairment levels consistent with persistent asthma

Question 15

What is the initial at home tx for an asthma attack?

Answer 15

Inhaled SABA (i.e., albuterol)

Question 16

If pt has sx’s >2 days per week, which classification of asthma do they have?

Answer 16

Persistent

Question 17

What 4 things should you educate a patient on after starting them on medication for asthma?

Answer 17

• Treatment goals
• Inhaler technique
• Elimination of triggers
• Asthma action plan

Question 18

What are the 3 treatments use in combo for pt having exacerbation of their asthma (aka asthma attack)?

Answer 18

• SABA (i.e., albuterol)
• Oxygen
• Oral corticosteroids