Flashcards in Asthma and Asthma Pharm Deck (85)
Things we always have to ask about in the history to diagnose asthma?
Coughing! Always have to ask about a night time cough. Wheezing too but not always present
How would we set up successful management of asthma?
1. Routine monitoring of lung function
2. Patient education
3. Environmental factors (avoid triggers)
4. Pharm (taper down or taper up step wise approaches)
What is asthma?
A chronic inflammatory disorder of the airways.
Kids with what kind of symptoms often test positive for asthma?
children with atopy/eczema risk factors for asthma. obesity- sleep apnea also would cause asthma exacerbations by increasing chronic inflammation
Definition of asthma?
A complex disorder characterized by variable and recurring symptoms,
1. airflow obstruction,
2. bronchial hyperresponsiveness and an
3. underlying inflammation.
What are the three things that cause airflow limitations?
Describe the following:
---Bronchial smooth muscle contraction in response to exposure to a variety of stimuli
---Exaggerated bronchoconstrictor response to stimuli
---Edema, mucus hypersecretion, formation of thickened mucus plugs
Asthma is characterized by episodic, reversible _____ resulting from an exaggerated ______ ______ to various stimuli.
Symptoms patterns for asthma can vary. Describe how they can present?
1. Perennial versus seasonal
2. Continual versus episodic
3. Duration, severity and frequency
4. Diurnal variations (nocturnal and early morning)
Inflammatory response involves multiple players
The trigger or stimulus may be exposure to intrinsic or extrinsic host factors such as?
Describe the following in how they affect asthma pts:
-- release granular protein that damages bronchial epithelium and promotes airway hyper-responsiveness. (allergic and parasites)
-- produce Cytokenes, Leukotriene B-4 and C-4, prostaglandin and histamine. (viral)
-- initiate arousal condition in IgE receptors
What are leukotrienes?
How do they work in exacerbating asthmatics?
Potent Inflammatory Mediators
1. Increased vascular permeability /edema
2. Increased mucus production
3. Decreased mucociliary transport
4. Inflammatory cell recruitment i.e. eosinophils—release inflammatory mediators i.e. cationic proteins
5. LTD4: profound bronchoconstriction, about 1000 x more potent than histamine
Describe the early phase of an asthma exacerbation?
1. IgE is secreted by plasma cells, binds to receptors on mast cells and basophils
2. Mast cells release mediators that contract airway smooth muscle directly
Describe the late phase of an asthma exacerbation?
1. Recruitment of inflammatory and immune cells, including the eosinophil, basophil, neutrophil, and helper, memory T-cells to sites of allergen exposure.
2. Dendritic cells are also recruited and play an important role.
3. The late phase reaction is more complex than just causing smooth muscle contraction.
What is the difference between instrinsic and extrinsic asthma?
1. Considered non-immune
Serum IgE levels are normal
2. Usually develops in later life
3. Usually no personal or family hx
1. Type-1 Hypersensitivy reaction
-Associated with other allergic manifestations
2. Onset is usually the first two decades of life
3. Family history
Stimuli that have little or no effect in normal subjects can trigger bronchospasm in intrinsic asthmatics. What are examples of these?
2. Pulmonary infections (especially viral)
4. Psychological stress
6. Inhaled irritants
8. Post nasal drip
What is samters triad?
aspirin, allergy/ rhinitis, nasal polyps
What is usually elevated in extrinsic asthma pts?
Serum IgE and eosinophil count are usually elevated
Occupational asthma and
Allergic bronchopulmonary aspergillosis are categorized as what kind of asthma?
What is exercise induced asthma?
Can be found in asthmatics, patients with the following types:
Exercise or vigorous physical activity triggers acute bronchospasms in persons with heightened airway reactivity.
Can be found in asthmatics, patients with
2. allergic rhinitis, or even
3. healthy persons
1. Beta-Agonist 10-15 minutes before activity
2. Avoid activity in cold air if possible
Classic triad of symptoms
1. Persistent wheeze, end expiratory wheeze
2. Chronic episodic dyspnea
3. Chronic cough
Associated Symtpoms in asthmatics?
1. Tachypnea, tachycardia, and systolic hypertension
2. Audible harsh respirations, prolonged expiration, wheezing
3. Sputum production (yellow sputum is probably underlying asthma)
4. Chest pain or tightness
5. Hemoptysis (pretty rare)
6. Diminished breath sounds during acute exacerbations
7. Pulses paradoxus (pulse rate changes with inspiration and expiration)- asthma, tamponade, pericarditis, sleep apnea. systolic blood pressure change and pulse change
What should we ask about the timing of these symtpoms?
Symptoms may be worse or only present at night
What should be in our diff for asthma?
1. COPD (usually in older pts)
3. Foreign body ingestion
4. Congestive heart failure
5. Pulmonary embolism
6. Panic disorder, hyperventilation syndrome
7. Pneumonia, bronchitis
8. Alpha1-Antiprypsin Deficiency (leads to COPD)
10. Sarcoidosis (thickening of the lungs)
11. Vocal Cord Dysfunction
12. Cough secondary to drugs (ACE inhibitors)- lisinopril
With hemoptysis, should consider:
1. Allergic bronchopulmonary aspergillosis
2. Bronchiectasis (cystic fibrosis)
3. Lung carcinoma
Indicators for considering a Dx of Asthma:
Any history of:
2. Cough (worse particularly at night)
3. Recurrent wheeze
4. Recurrent difficulty in breathing, recurrent chest tightness
Indicators for considering a Dx of Asthma:
Symptoms occur or worsen in the presence of?
2. Viral infection
3. Inhalant allergens and irritants
4. Changes in weather
5. Strong emotional expression (crying, laughing)
7. Menstrual cycles
What is needed to establish an asthma diagnosis?
PFT results for asthma pts will show?
Inflation will be?
What FEV1 change shows reversibility?
Obstructive disease that is reversible
Decreased FEV1 less than 80% predicted
FEV1/FVC less than 65%
FEV1 increase of > or = 12% and at least 200ml after using a short acting B2 agonist.