Asthma

Asthma

Asthma

A chronic, obstructive, inflammatory lung disease characterized by increased airway responsiveness to a stimuli, airway narrowing, symptoms, and lung air trapping

airway narrowing, goblet cell hyperplasia, denudation of airway epithelium

Pathophysiology of asthma

history of atopy, obesity, family hx of asthma

Risk factors for Asthma

Allergic, Nonallergic, adult onset, exercise-induced bronchoconstriction

Asthma variants

pulmonary function test (PFT), spirometry

For children above the age 6, how do you confirm a diagnosis of asthma

do a PFT before and after a SABA if you can reverse the obstruction think asthma

How is the PFT test used to diagnose asthma

If you see a decrease in FEV1 by 20% or more its positive

How can you use bronchoprovocation with methacholine/histamine to to diagnose asthma (not in peeps with a FEV1 less than 65%)

Peak expiratory flow measurement (PEF)

What is a tool that provides a quick measurement of forced expiration following full inspiration and is used for monitoring during treatment

green zone

In a PEF that shows 80-100% of personal best or normal peak flow, this would be in the

yellow zone (start a home action plan)

In a PEF that shows 50-80% of personal best or normal peak flow, this would be in the

Red zone (ER time - MY HOUSE)

In a PEF that shows less than 50% of personal best of 200L , this would be in the

activation leads to bronchodilation (smooth muscle relax)

How do Beta 2s help in treating asthma

albuterol, levalbuterol, terbutaline

Short acting B2 agonist (SABAs)

Salmeterol, formoterol

Long acting B2 agonist (LABAs)

nebulizer

Which has a higher concentration of medication, Nebulizer or MDI w/spacer

smooth muscles relax, reduce mucous secretions

How do anticholinergics help treat asthma?

ipratropium bromide

Short acting muscarinic agonists (SAMAs)

SAMA

1st line treatment in b-blocker induced asthma and SABA intolerant patients

Tiotropium, umeclidinium

Long acting muscarinic agents (LAMAs) that can be used in combination with B2 agonist due to synergistic effect

fluticasone, budesonide, mometasone

Which corticosteroids are used to treat asthma with persistent symptoms, although it takes months for maximum effect

Oral/injectable corticosteroids (prednisone, methylprednisone)

What is the most effective option in controlling exacerbations?

Leukotriene receptor antagonist (Montelukast (singulair))

What can assist with long-term symptoms/inflammation associated with asthma although it has no immediate effects?

phosphodiesterase inhibitor (theophylline)

What is an adjunct therapy used for moderate/severe symptoms when asthma cannot be contained with corticosteroids BUT must be monitored due to narrow TI?

Mast cell inhibitor (cromolyn sodium)

What medication prevents the mast cell release of histamine and leukotrienes, but is only effective if taken regularly and prior to exposure to trigger?

Asthma Exacerbation (attack)

An acute worsening of inflammation, airway restriction, and obstruction?

Asthma attack, COPD, bronchiolitis, bronchitis, croup, bacterial tracheitis, foreign body aspiration

Patient presents to the ER with difficulty breathing. You note an audible wheezing even without auscultation of the lungs and prolonged expiration. The patient is showing signs of respiratory distress as well as pursed lips. Based on this, what is in your differential?

Normal/respiratory alkalosis (decreased CO2), normal O2 sat, Normal or high PaO2

How is a Blood gas going to look in a mild asthma exacerbation?

Respiratory alkalosis, Decreased SPO2 and PaO2

How is a Blood gas going to look in a moderate asthma exacerbation?

Respiratory Acidosis, greatly increased CO2, Decreased SPO2/PaO2

How is a Blood gas going to look in a severe asthma exacerbation?

normal/hyperinflation

What might a CXR show in an asthma exacerbation

If there’s sign of infectious etiology

When would you get a CXR if you where thinking asthma exacerabation

Apply oxygen, repeated SABA/SAMA combo, Corticosteroids (oral or IV)

A patient presents to the ER for an asthma attack. They report they have used their albuterol inhaler multiple times to no avail. What is your game plan?

IV Mg, intubate (if they look like they’re gonna crash)

If your asthma attack patient doesn’t respond to standard treatment, what’s the next step?

Talk to the patient (clinical status), walk of life, PEF, serum CO2

How can we monitor our peeps with asthma excerbations?

Slowing of RR, depressed mental state, inability to maintain respiratory effort, worsening hypercapnia, respiratory acidosis, inability to maintain an O2 sat above 92 with face mask

When are we intubating an asthma excerbation?

uncertain of diagnosis, uncontrolled, occupational, frequent exacerbation, life threatening attacks, ADRs are intolerable

When are we referring a asthma patient to pulmonology or allergist?

NO

Do kids grow out of their asthma?

inhaled corticosteroids (ICS)

What is the 1st line standard of care for every type of asthma patient but is usually expensive?

ICS-SABA PRN

For adults and teens suffering from asthma symptoms 2 days a week what is our game plan?

Low dose ICS (maintenance), ICS-SABA PRN

For adults and teens suffering from asthma symptoms 3-6 days a week what is our game plan?

Maintenance w/ low dose ICS-SABA, ICS-SABA PRN

For adults and teens suffering from asthma symptoms daily what is our game plan?

Maintenance w/ moderate dose ICS-SABA, ICS-SABA PRN

For adults and teens suffering from asthma symptoms daily that limits ADLs what is our game plan?