Lecture 56 - Dx and Tx of Asthma

Question 1

what is asthma?

Answer 1

What is it? Chronic inflammatory d/o of the airways

Intermittent; Recurrent episodes of: wheezing, coughing, breathlessness, and chest tightness

Question 2

What cells are involved with an asthmatic reaction?

Answer 2

Cells involved: T lymphocytes, macrophages, mast cells, eosinophils, and epithelial cells

Question 3

How does asthma differ from COPD

Answer 3

Asthma – airway obstruction from inflammation/smooth muscle contraction

COPD - destruction of the parenchyma; increased compliance; airway collapse

Question 4

What factors are used for the dx of asthma ?

which are the most important

Answer 4

History

Physical

PFTs – most important

Imaging

Question 5

describe some HPI findings?

Answer 5

Symptoms often Manifest a young age
Symptoms: SOB, cough (w/ or w/o sputum), Chest tightness
Symptoms are intermittent, seasonal, exercise induced, environmental
Symptoms may occur in response to stimuli – allergens,

	PMH -- allergic disese (eczema, allergic rhinitis) 
	FH -- allergic diseases or asthma 
	Social -- themselves are often non smokers; ask about hobbies and occupational exposures, home environment (mold, carpets, pets)

Question 6

Physical exam findings of asthma?

Answer 6

Physical Exam:
Wheezing – cardinal finding; high pitched sound on expiration
Hyper resonance on percussion
Vital Signs – depends on severity of symptoms; tachycardia, tachypnea

Question 7

Spirometry findings of an obstructive lung disease?

Answer 7

Low FVC
Low FEV1
Low FEV1/FVC

Question 8

how can you tell if the lung obstuction is reversible ?

Answer 8

Bronchodilator Response:
12% (10-15%) Change in FEV 1,
that is at least 200 cc improved

Question 9

What is another pharmacological test to help confirm a diagnosis of asthma ?

Answer 9

Testing Bronchial Hyper-responsiveness:

• administer increasing doses of Methacholine (cholinergic agonists);
  Patient is asthmatic with >20% decline in FEV1

Question 10

what is a short term treatment for asthma?

Answer 10

Rescue Inhalers – SABA

Question 11

what are some long term control medications for asthma ?

Answer 11

Inhaled Corticosteroids

LABA

Leukotriene Modifiers

Mast Cell Stabilizers

Immunomodulators – Omalizumab

Question 12

asthma severity:
Mild Intermittent

Mild Persistent

Answer 12

Mild Intermittent
- rare night time symptoms
Symptoms < 2 x week;
Asymptomatic and normal PFTs been exacerbations

Mild Persistent
Night Time sx > 2 x per month

Symptoms > 2 x a week but less than 1 x per day

Question 13

Asthma severity

Moderate persistent

Answer 13

Moderate Persistent: 
night time > 1x per week 
Daily symptoms 
daily use of SABA 
Exacerbations affect activity and occur > 2 x week 

Severe Persistent:
Frequent night time symptoms

Continual symptoms which limite physical activity; frequency exacerbations

Question 14

STEP UP/STEP DOWN

• what is the baseline therapy?
• what meds are used from there ?

Answer 14

Baseline - SABA PRN

next: + low dow ICS
next: medium ICS + LABA
next: higher dose ICS + LABA (consider immuno)

next: ICS+ LABA + oral corticosteroid

Question 15

when are systemic corticosteroids usdd ?

Answer 15

severe exacerabations; uncontrolled asthma

Question 16

what 3 things should always be considered when treating patients? if overlooked the treatment might not work anyay

Answer 16

Adherence
Environmental Control
Comorbid Conditions

Question 17

What is the primary complication of asthma?

How can this lead to hypercapnea?

Treat?

Answer 17

Acute Asthma Exacerbations

Inadequate Ventilation or respiratory muscle failure

Treat: nebulized beta agonists; systemic corticosteroids; supportive care

Question 18

what are some special forms of asthma?

Answer 18

exercise induced

ASA sensitive

Work Related

Allergic Bronchopulmonary aspergillosis

Asthma in pregnancy