Term
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Definition
| Chronic inflammatory disorder of the airways (large airways, brochi). Associated with variable airflow obstruction, often reversible |
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Term
| Greater prevalence of asthma in... |
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Definition
| Blacks and ppl below poverty line |
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Term
| Starts with inflammation, which leads to... |
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Definition
| airway hyper-responsiveness and airway obstruction |
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Term
| Inflammation of the the bronchi are due to... |
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Definition
| mucosal edema and increase mucus production |
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Term
| The airway hyper-responsiveness is mediated by... |
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Definition
the bronchoconstriction thru vagal pathways
-stimulation of bronchial smooth muscle
-beta2 adrenergic receptor stimulation
-cholinergic mechanism via vagus constricts w/ airway irritants |
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Term
| Changes in lung volumes in asthma |
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Definition
RV increased
FRC increased
VC decreased
TLC normal or increased |
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Term
| Clinical symptoms of asthma |
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Definition
wheeze
chronic cough
episodic dyspnea
recurrent chest tightness |
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Term
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Definition
allergens (dust, pet dander, etc)
smoke/fumes
cold
exercise
emotional stress
post nasal drip
viral resp infections |
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Term
| differential diagnosis in children |
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Definition
allergic rhinitis
sinusitis
obstruction of large airways (FB, vocal cord dysfxn, tumor, etc)
obstruction of small airways |
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Term
| differential diagnosis in adults |
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Definition
COPD
CHF
pulm embolism
mechanical obstruction
drug induced
GERD
ABPA
vocal cord dysfxn |
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Term
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Definition
GERD
sleep apnea
obesity
rhinitis/sinusitis
stress
allergic bronchopulmonary aspergillosis |
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Term
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Definition
tachypnea
nasal flarring
wheezing, prolonged expiratory phase, use of accessory muscles
paradoxic breathing
pulsus paradoxus |
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Term
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Definition
FEV1 decreased
FEV1/FVC decreased |
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Term
| Intermittent asthma- adult |
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Definition
symptoms <2days/wk
nighttime awakenings <2/month
SABA <2days/wk
interferes w activity- none
FEV1 >80%
FEV1/FVC normal
exacerbations 0-1/yr |
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Term
| mild persistent asthma- adult |
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Definition
symptoms >2days/wk (not daily)
nighttime awakenings 3-4x/month
SABA >2days/wk (not daily)
interferes w activity- minor
FEV1 >80%
FEV1/FVC normal
exacerbations >2/yr |
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Term
| moderate persistent asthma- adult |
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Definition
symptoms daily
nighttime awakenings >1x/wk (not daily)
SABA daily
interferes w activity- some
FEV1 60-80%
FEV1/FVC reduced by 5%
exacerbations >2/yr |
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Term
| severe persistent asthma- adult |
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Definition
symptoms thruout day
nighttime awakenings >2x/wk
SABA several times a day
interferes w activity- extremely
FEV1 <60%
FEV1/FVC reduced >5%
exacerbations >2/yr |
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Term
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Definition
SABA
anticholinergics
oral/IV corticosteroids |
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Term
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Definition
LABA
leukotriene modifiers
methylxanthines
mast cell stabilizers
corticosteroids
immunomodulators |
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Term
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Definition
relax smooth muscle
releve acute symptoms
max bronchodilation in 30 min, duration 3-4 hrs
side effects: tachycardia, dizziness, tremor
ex: Albuterol, levalbuterol, pirbuterol |
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Term
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Definition
reduce vagal tone of airway and block contraction of airway
Ipratropium bromide |
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Term
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Definition
anti-inflammatory
for acute exacerbation
causes hyperglycemia, leukocytosis, elevated BP
prednisone, methylprednisone |
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Term
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Definition
anti-inflammatory
can cause oral candidiasis, hoarseness and growth delay
Fluticasone, budesonide, triamcinolone |
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Term
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Definition
relax smooth muscle
duration >12 hrs
not for acute symptoms
salmeterol, formoterol
can reduce efficacy of SABAs |
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Term
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Definition
block leukotriene synthesis
chronic use
Montelukast, zafirlukast, zileuton |
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Term
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Definition
alter fxn of Cl channels- inhibit cellular activation
prior to exercise
no relief of bronchospasm |
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Term
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Definition
bronchodilator
narrow therapeutic range
side effects: anorexia, nausea, vomiting, seizure and arrhythmias |
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Term
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Definition
decrease mast cell degranulation
for severe persistent asthma
subQ injection
Omalizumab |
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Term
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Definition
stop smoking
avoid aspirin and NSAIDs
reduce allergen exposure
avoid sulfites in diet
available immunizations |
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Term
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Definition
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Term
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Definition
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Term
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Definition
0-4 y.o.- medium dose ICS
5-11yo- low dose ICS+LABA/LTRA/theo or medium dose ICS
adults- low dose ICS + LABA or medium dose ICS |
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Term
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Definition
0-4 y.o.- medium dose ICS+ LABA/montelukast
5-11yo- medium dose ICS+LABA
adults- medium dose ICS + LABA |
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Term
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Definition
0-4 y.o.- high dose ICS + LABA/montelukast
5-11yo- high dose ICS+LABA
adults- high dose ICS + LABA; consider omalizumab |
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Term
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Definition
0-4 y.o.- high dose ICS + LABA/montelukast + oral corticosteroid
5-11yo- high dose ICS+LABA+ oral steroid
adults- high dose ICS + LABA+ oral corticosteroid; consider omalizumab |
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Term
| therapy based on classification of asthma |
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Definition
step 1- intermittent
step 2- mild persistent
step 3/4- moderate persistent
step 5/6- severe persistent |
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Term
| therapy based on current control |
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Definition
well controlled- keep current step, go down if stable +3months
not well controlled- step up at least one
poorly controlled- consider systemic steroids |
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Term
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Definition
reverse bronchospasm
decrease inflammation
oxygenate |
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Term
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Definition
still wheezing
accessory muscle use
req. O2 to keep O2 sat>92%
PEFR <69% |
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Term
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Definition
resp distress
pt fatigue
pulsus paradoxus
impending resp failure
AMS
O2 sat <90% with O2
increasing PaCO2 |
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Term
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Definition
stimulate sympathetic innervation T1-6 (rib raising)
parasympathetic innervation- vagus (OA decompression)
breathing mechanics (rib and diaphragm dysfxns) |
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Term
| intermittent asthma- child (what's different from normal adult classification) |
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Definition
ages 0-4: nighttime awakenings 0
PFT- not assessable
ages 5-11: FEV1/FVC >80% |
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Term
| mild persistent asthma- child (what's different from normal adult classification) |
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Definition
age 0-4: nighttime awakenings 1-2x/mo
PFT not assessable
age 5-11: FEV1/FVC >80% |
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Term
| moderate persistent asthma- child (what's different from normal adult classification) |
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Definition
age 0-4: nighttime awakenings 3-4x/mo
PFT not assessable
age 5-11: FEV1/FVC 75-80% |
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Term
| severe persistent asthma- child (what's different from normal adult classification) |
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Definition
age 0-4: nighttime awakenings >1x/wk
PFT not assessable
age 5-11: FEV1/FVC <75% |
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