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RCP 115 ch 14
Asthma
| Question | Answer |
|---|---|
| Asthma is characterized by? | - Chronic airway inflammation. - Symptoms vary over time and intensity. - Includes varible expiratory air flow limitation |
| Some common respiratory symptoms of Asthma? | - Wheezing - SHOB - Chest tightness - Cough |
| What are some different types of asthma? | - Asthma with obisity - Allergic asthma - Non- allergic asthma - Late- onset asthma - Asthma with fixed air flow limitation |
| What two organizations update clinical guidelines for asthma, that are developed and disseminated on a regular basis? | 1) The National Asthma Education and Prevention (NAEPP). 2) The Golbal Initiative for Asthma (GINA). |
| What organization was the first evidence- based asthma guidelines published in 1991? | National Asthma Education and Prevention Program (NAEPP). |
| NAEPP was under the coordination of what organization for the first evidence- based asthma guidelines? | National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. |
| The NAEPP guidelines are structured around what four components? | 1) Assessment and monitoring of asthma. 2) Patient education. 3) Control of factors contributing to the asthma severity. 4) Pharmacologic treatments. |
| What two organizations launched The Global Initiative for Asthma? | -National Heart, Lung, and Blood INstitute (NHLBI) of the National Institutes of Health. - World Health Organization (WHO). |
| GINA's Specific Goals: | - Increased awareness of asthma and its public health consequences. - Promote identification of reasons for the increased prevalence of asthma - Promote study of the association between asthma and the environment - Reduce asthma morbidity and mortality |
| GINA's Specific Goals (continued) | Improve management of asthma - Improve availability and accessibility of effective asthma therapy. |
| What are the anatomic alterations of the lungs? | - Smooth muscle constriction of bronchial airways - Excessive production of thick, whitish bronchial secretions - Mucus plugging - Hyperinflation of alveoli - Severe cases, atelectasis by mucus plugging - Bronchial wall inflammation leading fibros |
| About how many million adults and children have asthma? | - 18.4 million adults (7.6%). - 6.2 million children (8.4%) |
| What are the host factors that put people at risk for asthma? | - Genetics - Obesity - Sex |
| What are the environmental factors that put people at risk for asthma? | - Allergens- outdoor and indoor air pollution. - Infections - Occupational - Tobacco smoke - Diet |
| What are some ther risk factors in asthma? | - drugs - food additives and preservatives - exercise- induced bronchoconstriction - gastroesophageal reflux - sleep (nocturnal asthma) - emotional stress - perimenstrual asthma - allergic bronchopulmonary aspergilosis |
| Perimenstrual Asthma (catamenial asthma) | - premenstrual and menstrual periods - often peak 2-3 days before menstruation begins |
| Allergic bronchopulmonary aspergillosis (ABPA) | - exaggerated response of the immune system - hypersensitivity response |
| The presence of any of these signs and symptoms should increase the suspicion of asthma? | - Wheezing - Symptoms occur or worsen at night, awakening the patients - Symptoms occur or worsen in a seasonal pattern - The patient also has eczema, hay fever, or a family history of asthma or atopic diseases |
| Diagnosis of asthma; Wheezing- history of any of the following; | - cough - recurrent wheeze - recurrent difficult breathing - recurrent chest tightness |
| Asthma syptoms occur or worsen in the presence of: | - animals with fur - aerosol chemicals - changes in temperature - domestic dust mights - drugs (ASA, B-blockers) - Exercise - pollens - respiratory (viral) infections - smoke - strong emotional expression |
| Diagnostic and Monitoring Tests for Asthma: FEV1; | after inhaling a bronchodilato- - Adults; > 12% (or > or = 200mL) - children; >13% |
| Diagnostic and Monitoring Tests for Asthma: PEFR: | Daily variability; -adults; >10% - children; >13% |
| Diagnostic and Monitoring Tests for Asthma: FEV1/ FVC ratio is reduced; | - Normal is more than 0.75- 0.80 in adults. - Normal is greater than 90% in children |
| Diagnostic and Monitoring Tests for Asthma: FEV1; after 4 weeks of anti inflammatory therapy; | increases by greater than 12% and (or >= 200mL) - or PEFR by greater than 20% on the same peak expiratory flowmeter. |
| What are some other Diagnostic Tests for Asthma | - bronchial provocation test (inhale methacoline) - allergy tests - exhaled nitic oxide |
| Bronchial provocation test | assessing airway hyper responsiveness |
| The diagnosis of asthma in special populations | - cough- variant asthma (non stop cough that doesn't go away) - occupational and work- aggravated asthma - athletes - pregnant women - elderly - smokers and ex- smokers - pts already taking comtroller meds. - obese pts. |
| The following clinical manifestations result from the pathophysiologic mechanisms caused (or activated) by | - bronchospasm - excessive bronchial secretions |
| The physical examination for asthma | - v/s - increased anteroposterior chest diameter - cyanosis - cough + sputum production - pulsus paradoxus - use of accessory muscles of inspiration and expiration - pursed lip breathing - substernal intercostal retractions |
| The physical examination; vital signs | - Increased; -RR (tachypnea) - HR (pulse) - B/P |
| Pulsus Paradoxus | - decreased B/P insiration - increased B/P expiration |
| What are some findings that you would find in the chest assessment of asthma? | - Expiratory prolongation (I:E ratio >113) - decrease tactile + vocal fremitus - Hyperresonant percussion - diminished heart sounds - wheezing - crackles |
| PFT findings; Moderate to Severe Asthma Episode (OBSTRUCTIVE Lung Patho) Forced Expiratory Volume and Flowrate Findings: | FVC. FEVt FEV1/FVC ratio. FEF 25%- 75% ↓. ↓. ↓. ↓ FEF50%. FEF 200-1200. PEFR. MVV ↓ ↓ ↓. ↓ |
| PFT findings; Moderate to Severe Asthma Episode (OBSTRUCTIVE Lung Patho) Lung Volume and Capacity Findings; | Vt. IRV. ERV. RV. VC N or ↑. N or ↓. N or ↓. ↑. ↓. IC FRC. TLC. RV/TLC ratio N or ↓. ↑. N or ↑. N or ↑ |
| ABGs Asthmatic Episode: Mild to Moderate Stages: Acute Alveolar Hyperventilation with Hypoxemia (Acute Respiratory Alkalosis) | pH. PaCO2. HCO3. PaO2. SaO2/SpO2 ↑. ↓. ↓ ↓ ↓ (normal) |
| ABGs Asthmatic Episode: Severe Stage; Acute Ventilatory Failure with Hypoxemia; (Acute Respiratory Acidosis) | pH. PaCO2 HCO3. PaO2. SaO2/SpO2 ↓. ↑. ↑. ↓. ↓ (normal) |
| Abnormal Laboratory Tests and Procedures; - Sputum examination: | - Eosinophilia - Charcot- Leyden crystals - Cast of mucus from small airways (Kirschman Spirals) - IgE level (elevated in extrinsic asthma). |
| What are some radiologic findings? (chest radiograph) | - increase anteroposterior diameter (barrel chest) - translucent (dark) lung fields - depressed or flattened diaphragm |
| What are some long- term goals for asthma management? | - symptom control - risk reduction of future exacerbations |
| What are some control- based asthma management program? | - controller medications - reliever (rescue) medications - add- on therapies for patients with severe asthma |
| What is the Stepwise management approach? | - STEP 1: as needed reliever inhaler. - STEP2: low dose controller medication. Plus needed reliever medications. - STEP 3 + 4: - 1 or 2 controllers, plus as- needed reliever medication - STEP 5: higher level care and/or add- on treatment |
| What are the general management of asthma? | - nonpharmacologic interventions - indications for referral for expert evaluation - management of asthma exacerbations - special populations |
| What are some respiratory care treatment protocols? | - aerosolized medication protocol - oxygen therapy protocol - mechanical ventilation protocol |
Created by:
tracyb34
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