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45 Cards in this Set
- Front
- Back
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A chronic inflammatory disorder of the airways |
asthma
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% of US population with asthma |
5-10
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how many hospitalizations/deaths annually from asthma
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500,000 5,000 |
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asthma occurs predominantly in which group
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boys in childhood 2:1 ratio until puberty,then m/f becomes 1:1 |
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what fraction of all asthma cases are diagnosed before age 18 |
2/3
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how many children diagnosed with asthma have a decreased or disappearance of sx by early adulthood
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1/2
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definition of asthma
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a complex disorder characterized by variable and recurring sx, airflow obstruction, bronchial hyperresponsiveness and an underlying inflammation
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3 Airflow limitations in asthma
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bronchoconstriction airway hyperresponsiveness airway edema |
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4 ways asthma sx patterns can vary
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perennial versus seasonal continual vs episodic duration, severity and frequency diurnal variations (nocturnal and early morning) |
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role of eosinophils in asthma
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release granular protein that damages bronchial epithelium and promotes airway hyperresponsiveness
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role of lymphocytes in asthma
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produce cytokines, leukotriene b4 and c4, prostaglandin and histamine
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MAST cells role in asthma
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initiate arousal condition in IgE receptors
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profound bronchoconstriction, about 1000 x more potent than histamine |
LTD4
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what do leukotrienes do
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increased vascular permeability/edema increased mucus production decreased mucociliary transport inflammatory cell recruitment (eosinophils release inflammatory mediators eg cationic proteins) LTD4 bronchoconstriction |
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what happens in the early phase of asthma
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IgE is secreted by plasma cells, binds to receptors on mast cells and basophils mast cells release mediators that contact airway smooth muscle directly |
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what happens in the late phase of asthma
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recruitment of inflammatory and immune cells, including eosinophil, basophil, neutrophil, and helper, T memory T celss to sites of allergen exposure dendritic cells are also recruited and play an important role the late phase reaction is more complex than just causing smooth muscle contraction |
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in which form of asthma are IgE levels normal |
intrinsic (non immune)
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intrinsict asthma
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considered non immune usually no personal or family hx serum IgE levels are normal usually developes later in life stimuli that have little or no effect on normal subjects can trigger bronchospasm ASA Pulmonary infections (esp. viral) cold psychological stress exercise inhaled irritants GERD Post nasal drip |
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what kind of hypersensitivity is extrinsic asthma
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type 1
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what is EIA
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exercise induced asthma an asthma variant exercise or vigorous pa triggers acute bs in persons with heightened airway reactivity can be found in asthmatics, patients with atopy, allergic rhinitis, or even healthy persons |
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tx of eia
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beta-agonist 10-15 minutes before activity avoid activity in cold air if possible |
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what is atopy
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a clinical hypersensitivity state or allergy with a hereditary predisposition; the tendency to develop an allergy is inherited,
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classic triad of asthma sx
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persistent wheeze, end expiratory wheeze chronic episodic dyspnea chronic cough |
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associated sx of asthma (non triad)
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tachypnea, tachycardia, systeolic htn audible harsh respirations, prolonged respiration, wheezing sputum production chest pain or tightness hemoptysis diminished breath sounds during acute exacerbations pulses paradoxus |
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what is pulses paradoxus
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Pulsus paradoxus (PP), also paradoxic pulse or paradoxical pulse, is an abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mm Hg. When the drop is more than 10 mm Hg, it is referred to as pulsus paradoxus.
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DDx of asthma
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COPD anaphylaxis CHF Foreign body ingestion PE Panic disorder, hyperventilation syndrome pneumonia, bronchitis alpha1-antiprypsin deficiency GERD sarcoidosis volcal cord dysfunction cough secondary to drugs (ACE inhibitors) |
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with hemoptysis, consider
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allergic bronchopulmonary aspergillosis bronchiectasis lung carcinoma TB |
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what is bronchiectasis
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Bronchiectasis is a disease in which there is permanent enlargement of parts of the airways of the lung. Symptoms typically include a chronic cough productive of mucus.
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_____ is a disease in which there is permanent enlargement of parts of the airways of the lung. Symptoms typically include a chronic cough productive of mucus.
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bronchiectasis
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4 indicators for considering Dx of asthma |
wheezing any hx of: cough worse at night in particular recurrent wheeze recurrent difficulty in breathing, recurrent chest tightness sx occur or worsen in the presence of exercise, viral infection, inhalant allergens or irritants, changes in weather, strong emotional expression (crying, laughing), stress, menstrual cycles sx occur or worsen at night, awakening the patient |
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the presence of multiple key indicators increases the probablity of asthma, but _____ is needed to establis a dx
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spirometry
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diagnostic studies for asthma
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PFT Provocation testing with methacholine or histamine |
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PFT results
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decreased FEV1<80% predicted FEV1/FEV <65% hyperinflation establish reversibility - FEV1 increase of > or = 12% and at least 200mL after using short acting beta 2 agonist |
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provocation testing with _____ or _____
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methacholine or histamine detects bronchal hyperactivity supports dx of asthma sometimes done when asthma is susptected but PFT's are near normal |
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Diagnostic tests for asthma
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chest xray may not show much, but will help rule in pneumonia, CHF, pneumothorax, airway lesions or FBO GE reflux assessment skin tests (demonstrate atopy) blood tests (eisinophils and IgE elevations (these support dx, absence does not exclude asthma) |
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partial or complete collapse of the lung
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atelectasis
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atelectasis
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partial or complete collapse of the lung
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Global strategy for asthma prevention (7) |
achieve and maintain control of sx prevent asthma exacerbations maintain pulmonary function as close to normal levels as possible maintain normal activity levels, including exercise avoid adverse effect from asthma medications prevent the development of irreversible airflow limitation prevent asthma mortality |
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frequency of follow up visits for asthma
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1-6 months depending on severity of asthma
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aspects of asthma assessed at each visit
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signs and symptoms pulmonary function quality of life exacerbations adherence with tx and se patient satisfaction with care |
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What do peak flows do
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monitor airway obstruction alter long term therapy for optimal control of sx keep diary have clar plan in place for using peak flow info to intervene early in exacerbations |
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4 classifications of asthma for stepwise management approach
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step 1: mild intermittent step 2: mild persistent step 3: moderate persistent step 4: severe persistent |
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status asthmaticus
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severe bronchospasm that is unresponsive to routine therapy can be sudden and rapidly fatal most pts have a hx of progressive dyspnea, over hours to days, with increasing bronchodilator use |
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presentation of status asthmaticus
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difficulty talking using accessory muscles of inspiration orthopnea diaphoresis mental status changes |
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treatment of status asthmaticus
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oxygen oximetry ABG's peak flows with treatments (inhaled b2 agonists, inhaled anticholinergics, oral or IV corticosteroids) if inadequate response, hospital admission if good response, d/c with inhled b2 agonist, inhaled anticholinergic, oral corticosteroids x 5 days (steroid burst) follow up within 5 days |
