Term
| A chronic inflammatory disorder of the airways characterized by reversible airway obstruction |
|
Definition
|
|
Term
| Inflammatory Process: Acute effects (reversible) |
|
Definition
| Acute bronchoconstriction, airway edema, mucus hypersecretion |
|
|
Term
| Features of asthmatic airway remodeling |
|
Definition
-subepithelial fibrosis
-increased numbers and volume of mucous cells in the epithelium
-increased amounts of airway smooth muscle
-increased vascularization of the airway wall |
|
|
Term
|
Definition
|
|
Term
| Obstuctive asthma FEV1/FVC |
|
Definition
|
|
Term
| Restrictive (emphysema) FEV1/FVC |
|
Definition
|
|
Term
| compact; requires good coordination |
|
Definition
|
|
Term
| reduces oropharynx deposition, lower inhalation velocity required, reduced timing issues |
|
Definition
|
|
Term
| "softer" dose; cleaning once per week, priming required, do not immerse: no "float-testing" |
|
Definition
|
|
Term
| not for children < 4 years old; limited expiration date once opened; appears to have similar delivery efficiency as MDI with or without spacer |
|
Definition
|
|
Term
| ease of use, cost, time limitations, mobility, expiration date once opened |
|
Definition
|
|
Term
|
Definition
| cardiac tissue, positive chronotrope and inotrope |
|
|
Term
|
Definition
| pulmonary structures, vascular tissue, bronchodilitation, vasodilitation |
|
|
Term
| mainstay of acute exacerbation management; prevention of exercised induced asthma; temporary bronchoprotection; very high doses have been used in ER setting |
|
Definition
| short-acting beta agonists |
|
|
Term
| short-acting beta agonists common side effects |
|
Definition
| tremor, CNS stimulation, palpitations |
|
|
Term
| short-acting beta agonists (inhaled formulations) |
|
Definition
|
|
Term
| racemic mixure of both R(-) and S (+) enantiomers; inhaler, nebulizer solution, DPI; high dosing can be used in acute exacerbations |
|
Definition
|
|
Term
| R(-) enantiomer; less medication for the same effect; consider in patients who do not respond well to albuterol |
|
Definition
|
|
Term
| Chronic management, added to anti-inflammatory therapy |
|
Definition
| long-acting beta agonists |
|
|
Term
| 1 inhalation twice daily; long term prevention of symptoms, added to anti-inflammatory therapy; increased lipophilicity resulting in prolonged retention in lung tissue |
|
Definition
|
|
Term
| Long-acting beta2 agonists may increase the risk of asthma-related death; does not have indication for acute exacerbations |
|
Definition
|
|
Term
| Relief of acute exacerbations, used in addition to short acting beta 2 agonists; competitive inhibition of muscarinic cholinergic receptors |
|
Definition
|
|
Term
|
Definition
| Not effective in the prevention of exercise induced bronchospasm |
|
|
Term
| slower onset of action than beta2 agonists; appears to have some additive effects to beta2 agonists |
|
Definition
|
|
Term
|
Definition
| Theophyline, Aminophyline |
|
|
Term
| alternative additive long-term therapy (Rarely used); narrow therapeutic range |
|
Definition
|
|
Term
| blocks late allergen reaction, suppress the generation of cytokines, suppress the recruitment of airway eosinophils, suppress the release of inflammatory mediators |
|
Definition
|
|
Term
| Chronic management, daily or every other day dosing, taper to lowest effective dose |
|
Definition
|
|
Term
| Systemic Corticosteroids Long term side effects |
|
Definition
| Adrenal axis suppression, growth suppression, cataracts/glaucoma, immune suppression |
|
|
Term
| Systemic Corticosteroids Acute exacerbations |
|
Definition
| Onset 6-12 hours; treatment for 3-10 days (taper not needed); methylprednisolone (IV) and Prednisone, Prednisolone (PO) |
|
|
Term
| Systemic Corticosteroids Short Term use Adverse Effects |
|
Definition
| Fluid retention, mood alteration, increased appetite |
|
|
Term
| Cornerstone of chronic management, lower systemic side effects, dose related response |
|
Definition
|
|
Term
|
Definition
| not for acute management, therapeutic effect about 2 weeks, rinse mouth |
|
|
Term
| Fluticason/salmeterol (Advair); Budesonide/formoterol (Symbicort); Mometason/formoterol (Dulera) |
|
Definition
| inhaled corticosteroid + long acting beta agonist |
|
|
Term
Alternative: long-term therapy
Prophylactic treatment
Mast cell stabilizer |
|
Definition
|
|
Term
|
Definition
|
|
Term
Alternative: long-term therapy
Leukotriene receptor antagonist |
|
Definition
| Zafirlukast and Montelukast |
|
|
Term
Additive: long-term management for severe asthamtics
Persistent allergic asthma
Poorly controlled asthma |
|
Definition
|
|
Term
| Selectively binds to human IgE; expensive and slow onset of effect |
|
Definition
|
|
Term
|
Definition
| short acting beta2 agonists; SC epinephrine or terbutaline; anticholinergics; corticosteroids |
|
|
Term
| Outpatient management: Good response |
|
Definition
| short acting beta 2 agonist Q 3-4 hrs PRN; consider oral steroid |
|
|
Term
| Outpatient management: Incomplete response |
|
Definition
| Cont. short acting beta 2 agonist; oral steroid |
|
|
Term
| Outpatient management: Poor response |
|
Definition
| Repeat short acting beta 2 agonist NOW; oral steroid; TO ER |
|
|
Term
| Hospitalized/emergency department: moderate |
|
Definition
| inhaled beta 2 agonist; supplemental oxygen; consider oral steroid |
|
|
Term
| Hospitalized/emergency department: severe |
|
Definition
| nebulized beta 2 agonist + anticholingeric; supplemental oxygen; oral steroid |
|
|
Term
| Impending Respiratory Arrest |
|
Definition
| Nebulized beta 2 agonist + anticholinergic; intubation x/ 100% oxygen; IV steroid |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Step 1 (intermittent asthma) |
|
Definition
| short acting beta 2 agonist (SABA)- all ages |
|
|
Term
| Step 2 (persistent asthma) |
|
Definition
| low dose inhaled corticosteroid (ICS)- all ages |
|
|
Term
| Step 3 (persistent asthma): Age 0-4 yrs |
|
Definition
|
|
Term
| Step 3 (persistent asthma): Age 5-11 yrs |
|
Definition
| medium dose ICS OR low dose ICS; plus either LABA, leukotriene modifier or theophylline |
|
|
Term
| Step 3 (persistent asthma): Age > 12 yrs |
|
Definition
| medium dose ICS OR low dose ICS + LABA |
|
|
Term
| Step 4 (persistent asthma): Age 0-4 years |
|
Definition
| medium dose ICS + either LABA or Montelukast |
|
|
Term
| Step 4 (persistent asthma): Age 5-11 yrs |
|
Definition
|
|
Term
| Step 4 (persistent asthma): Age >12 yrs |
|
Definition
|
|
Term
| Step 5 (persistent asthma) : age 0-4 yrs |
|
Definition
| high dose ICS + either LABA or Montelukast |
|
|
Term
| Step 5 (persistent asthma): age 5-11 years |
|
Definition
|
|
Term
| Step 5 (persistent asthma) : age > 12 years |
|
Definition
| high dose ICS + LABA; consider Omalizumab for patients with allergies |
|
|
Term
| Step 6 (persistent asthma): age 0-4 yeras |
|
Definition
| high dose ICS + oral corticosteroids+ EITHER LABA or Montelukast |
|
|
Term
| Step 6 (persistent asthma) Age 5-11 years |
|
Definition
| High dose ICS + LABA+ oral corticosteroid |
|
|
Term
| Step 6 (persistent asthma) Age >12 years |
|
Definition
| high dose ICS + LABA+ oral corticosteroids; consider Omalizumab for patients with allergies |
|
|
Term
| Corticosteroids in children |
|
Definition
| growth, osteoporosis/fracture, cataracts, adrenal suppression |
|
|
Term
| poorly controlled asthma in pregnancy |
|
Definition
|
|
Term
|
Definition
| beta 2 agonist, inhaled corticosteroids, leukotriene modifiers, theophyline |
|
|
