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26 Cards in this Set
- Front
- Back
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Why do pts wheeze?
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the walls of the bronchi touch each other as air flow through them
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Unique perception of Asthma by Managed Care plans?
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Asthma is the only chronic disease managed care plans are willing to spend money to try and control/prevent b/c of its high frequency in the population and its fast and good response to Rx
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When do infants usually wheeze?
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As a post-viral (RSV) syndrome which is largely self-limited
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Typical Characteristics of Early Wheezers?
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15% develop persistent asthma
If persists past 5yo, may convert to Allergic Either way has elevated IgE and a maternal h/o asthma |
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Types of Adult Asthma Pts?
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Persistent from childhood
De novo Occupational |
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What other pts are chronic asthmatics hard to distinguish from?
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COPD pts
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How MIGHT you be able to distinguish chronic asthmatics from COPD pts?
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Response to Rx
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Typical Asthma Sx's?
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Wheezing
Intermittent Dyspnea Cough (and nocturnal cough) Exercise-induced wheezing and dyspnea |
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Signs of Asthma?
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Wheezing on Auscultation
(pursed lip breathing, use of accessory muscles) |
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Physiological Abnormalities w/ Asthma?
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Airflow Obstruction (varies over time)
Bronchodilator Responsiveness Increased Airway Reactivity |
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Asthma Variants?
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Some present with mainly:
Dyspnea Cough Anterior Chest Pains |
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patterns of asthma Sx's?
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Mild and Annoying
Severe, Life-Threatening Mild w/ sx's only following viral URI's lasting about 6 wks |
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Typical missed presentation of asthma?
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afebrile bronchitis
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Short List of Differential Dx?
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Environmental Allergy
Chronic Rhino-sinusitis GERD Aspirin Sensitivity OSA? |
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Why was wheezing such a distraction?
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It was what we used to always treat, but it distracted us from the underlying inflammation
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Why is compliance w/ anti-inflammatory Rx harder than wheezing Rx?
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B/c pts have to remember to take the anti-infl everyday but they only have to use their inhaler when they have a bout
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Asthma and ECM?
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Asthma leads to the degradation and new synthesis of ECM
= Remodeling |
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Why are glucocorticoids good for asthma?
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they inhibit or lower TNF-alpha, and other enzymes and cytokines from increases inflammation
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Steps to the assessment of an asthmatic pt?
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1. Confirm Dx and Assess severity
2. Determine possible triggers and inducers 3. Initiate Rx 4. EDUCATE!! 5. Determine how to achieve best results 6. Reduce meds onced asthma controlled 7. Devise action plan for exacerbations 8. Ensure follow-up |
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Keys to Asthma Control Test?
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In the past 4 weeks:
-how much did your asthma screw getting stuff done at work/home -how often dyspnea -how often did sx's wake you from sleep -how often had to use inhaler -how has your control of asthma been |
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Measurements/Tests of Asthma?
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PFT's
CXR ABG eNO |
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what is eNO all about?
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something w/ exhaled condensates which reflects level of inflammation
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When do you Rx allergies in asthma?
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-if inhalants aggravate allergies
-if asthma isn't too great of a risk in the event of systemic rxns |
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What is a good drug for Allergies in Severe Asthma?
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Omalizumab
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Criteria for Omalizumab use?
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Positive allergy test
Severe Asthma Total IgE between 35 and 700 IU |
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Effect of Omalizumab?
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good for asthma, but no long term change of allergies
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