Term
| what important definition change for asthma occured in 1991 with the NAEPP? |
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Definition
| R.O.A.D. previously defined asthma as a "spasmotic" disease, but it was re-defined as a inflammatory obstructive lung disease for which inhaled corticosteroids were the main form of tx (which addresses both the spasmotic and inflammatory aspects) which has shown improvement with treatment, but also an increase in costs |
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Term
| what are the two components of asthma pathophysiology? |
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Definition
| spasm of smooth muscle cells and airway inflamation causing dual pathway disruption. |
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Term
| how do smooth muscle cell (SMC) spasms cause asthma? |
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Definition
| direct airflow limitation |
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Term
| how does inflamation cause asthma? |
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Definition
| indirect inflammation mediated by neutrophils, eosinophils, and TH2-like lymphocytes (bx confirmed) |
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Term
| what are some consequences of asthma? |
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Definition
| airway hyperresponsiveness (twitchy to various stimuli), respiratory symptoms and chronic disease |
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Term
| what are histological characteristics of asthma? can these be found on asymptomatic asmatics? |
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Definition
| mucus gland hypertrophy, edema, basement membrane thickening, epilethial damaage, hypertrophy of airway smooth muscle, inflammatory cell infiltration, and vascular dilation. these same histological findings are seen in nonsymptomatic asthmatics -> due to chronicity of the disease |
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Term
| ***what are the top 4 clinical symptoms of asthma? is chest pain considered a symptom? |
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Definition
| coughing, wheezing, chest tightening and dyspnea. chest pain is not considered a clinical symptom of asthma |
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Term
| what are some ways to test for asthma? |
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Definition
| pt notices decreased endurance in exertional activity, decrease in variable airflow obstruction (wheezing/stridor) w/inhaler use, increase in symptoms if pt lies supine |
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Term
| what are some pathological signs of asthma? |
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Definition
| collagen deposition in lung tissue, smooth muscle hypertrophy, edema, increased mucus secretion, epithelial damage and airway inflammation |
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Term
| what are some questions to consider in diagnosis of asthma? |
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Definition
| has the patient had an attack/recurring attacks of wheezing? dA. Has the patient had an attack/recurring attacks of wheezing/after exposure to allergens/pollutants? does the patient have frequent colds which last longer than 10 days? (ask for head colds, lingering coughs or chest colds) how much albuterol does a patient use in a 30-day period? |
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Term
| what key phrases are a part of describing asthma? |
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Definition
| airway obstruction, hyperresponsiveness, inflammation |
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Term
| when diagnosing asthma, what are recurrent symptoms to be considered? what should be ruled out? what should be documented? what needs to be demonstrated? |
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Definition
| wheezing, cough, dyspnea. other potential causes should be ruled out. airflow obstruction should be documented: peak flow readings, spirometry, listen to breathing. reversibility of symptoms needs to be demonstrated, (ensure pt gets better) |
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Term
| what are the goals of asthma therapy? |
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Definition
| control chronic/nocturnal symptoms, maintain normal activity levels (including exercise), maintain near-normal pulmonary function, prevent acute episodes, minimize ER visits/hospitalization, avoid adverse effects of asthma medications |
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Term
| what are the five areas of management for asthma as determined in 1997/2002 by an expert panel report? |
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Definition
| goals, pt education, proper medication, objective measurement of lung function, and environmental control/allergy avoidance |
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Term
| what is pt education specific to asthma in terms of rx administration/avoidance? |
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Definition
| it is important that patients know how to self-administer medication in whatever form it is prescribed (using an inhaler, nebulizer, nasal sprays, etc. and only 15-18% of inhaler medication is actually absorbed per puff). it is also important pts know asthmatic triggers: strong emotions, (anger/laughing), infections, exercise, other medication, allergens, cold air, pollution, smoke, environmental changes, food additives, hormonal factors (menses), and that they keep animals out of bedroom. |
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Term
| what is a way that pts can monitor their lung function/level of asthma inflammation? |
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Definition
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Term
| what are the 2 kinds of asthma medications? |
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Definition
| controllers (taken daily to control asthma) and relievers (taken as needed to control flare-ups |
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Term
| what are the 4 OLD classifications of asthma? what is the threshold for prescribing anti-inflammatory drugs? |
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Definition
| mild intermittent, mild persistent, moderate persistant, and severe persistent. mild persistent is the threshold for prescribing anti-inflammatory drugs |
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Term
| how is the severity of asthma asessed? what are the most important factors? |
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Definition
| determining the frequency of asthma attacks and inhaler use, exercise tolerance, nocturnal awakenings, (school/work) attendance, lung function testing. **frequency of asthma attacks and lung function tests are the most important in classifying disease severity |
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Term
| if a pt has normal lung function what is their severity considered? how does rescue inhaler use frequency further define this? |
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Definition
| intermittent or mild persistent if normal lung function. if the pt uses their resuce inhaler 2-3x weekly they are intermittent persistent, if they use it almost every day, they are mild persistent. if the pt uses an inhaler EVERY DAY, but has normal lung function they are considered moderate persistent |
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Term
| in 2007, the third expert panel had to convene b/c mild-persistent pts were not getting better/lacked control so increased focus was addressing severity in what 3 ways? |
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Definition
| increased focus was placed on asthma control, reducing impairment, and reducing asthma risk |
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Term
| what does asthma control consist of? what is it the focus of? |
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Definition
| the degree to which asthma symptoms are minimized. symptom control is the focus of follow-up visits and the pt is classified as having well, not well, or poorly controlled asthma |
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Term
| how is asthma impairment assessed? |
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Definition
| how often rescue inhaler is used, symptom frequency/intensity, lung function results, functional limitations, asthma control test (taken in waiting rooms, good assessment of how much asthma impairs an individual’s life: 25-point scale; scoring above a score of 19 is “normal”) **pt may think their symptoms are minimized, but have a poor lung function test |
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Term
| what is asthma risk? what does assessing it consist of? |
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Definition
| an attempt to quantify the likelihood that a patient will have future exacerbations, ER visits/hospitalizations, progressive lung function decline, or side effects from medication. assessing it consists of determining oral steroid use, prior hospitalizations, spirometry and possibly exhaled nitrous oxide **also necessary to determine what allergens the pt is reactive to |
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Term
| what are the 4 new classifications for asthma severity? |
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Definition
| intermittent, mild persistent, moderate persistant, and severe persistent. mild was removed from "mild intermittent" and any level is considred valid for prescribing anti-inflammatory drugs |
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Term
| what are the methods of prevention of airway inflammation? |
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Definition
| allergy avoidance, allergy immunotherapy, intal (mast cell stabilizer, helps prevent release of inflammatory chemicals like histamine), tilade (helps with breathing problems), leukotriene modifiers (prevent action of fatty molecules modified from plasma membrane that contribute to inflammation), steroids, xolair (expensive drug for severe, persistent asthma uncontrollable even with high corticosteroid dosages) |
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Term
| what are leukotrienes involved in? |
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Definition
| bronchial constriction, mucus secretion and edema formation. leukotriene modifiers with singular help with this in asthma, allergies, and anaphylaxis. |
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Term
| how do steroids help with asthma? |
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Definition
| these potent drugs are targetat at 4 different targets: tissue swelling, beta-2 receptores, mediator release, and inflammatory cells |
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Term
| what do side effects from steroids depend on? |
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Definition
| route of administration (oral can be worse) and duration |
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Term
| what are benefits of steroids? |
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Definition
| reduce symptom severity, bronchial hyperactivity, rescue inhaler use and exacerbations/hospitalizations. improve pulmonary function. may prevent airway remodeling (changes in airway morphology). |
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Term
| what is the trend with steroid vs beta 2 inhalers and asthma pt hospitalization? |
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Definition
| the more people get their inhaled corticosteroid (ICS) prescriptions refilled, the less they get hospitalized, but the more they use their beta inhaler (rescue), the more hospitalizations are likely |
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Term
| can GERD exacerbate asthma? |
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Definition
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Term
| can VCD (vocal cord dysfunction mimic asthma? what differentiates it? |
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Definition
| VCD: vocal cords close up when breathing, mimics asthma in presentation (audible stridor) however they recover much faster |
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Term
| what are some things that can mimic asthma? |
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Definition
| sinusitis, GERD, VCD, pulmonary fibrosis |
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Term
| what does xolair/omalizumab do? what would warrant its prescription? |
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Definition
| binds IgE, inhibits the binding of IgE to the high-affinity IgE receptor, (Fc epsilon RI) on the surface of mast cells and basophils. it is initially expensive ($10-30K/year), but in comparison to full-scale hospitalization, very cost-effective |
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Term
| if a pt has clear lungs but a low pulse ox and a hx of dyspnea/chest pain, what might they have? |
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Definition
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