What is the purpose of the Asthma Control Test?
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To assess symptom control in asthma patients.
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What is the purpose of the Asthma Control Test?
To assess symptom control in asthma patients.
What characterizes asthma with persistent airflow limitation?
It occurs in long-standing asthma and is incompletely reversible due to airway wall remodeling.
What is one reason for short-term monitoring of peak flow?
To monitor recovery following an exacerbation.
What is a key feature of adult-onset (late-onset) asthma?
It is usually non-allergic and requires high doses of inhaled corticosteroids (ICS).
What can chronic asthma lead to in terms of airway structure?
Airway remodeling due to bronchial wall inflammation.
What do arterial blood gas studies typically show in asthma patients?
Decreased PaO2 and increased PaCO2.
When should peak flow monitoring be conducted after a change in treatment?
To help assess whether the patient has responded.
What is the prevalence of asthma in Hong Kong according to the 2011 Census and Statistics Department?
What is the purpose of long-term monitoring of peak flow?
For earlier detection of exacerbations, especially in patients with poor perception of airflow limitation.
Who benefits from long-term peak flow monitoring?
Patients with a history of sudden severe exacerbations.
What is the purpose of allergy tests in asthma diagnosis?
To assess the likelihood of allergic asthma, though they are not specific to asthma.
How do symptoms and airflow limitation in asthma vary?
They vary over time and in intensity.
How many deaths were caused by asthma in 2019?
455,000 deaths.
What will students identify related to nursing in asthma care?
The related nursing diagnoses and responsibilities for caring for clients with asthma.
What are typical respiratory symptoms indicative of?
Possible asthma diagnosis.
What are the predisposing factors for asthma?
Atopy and female gender.
What are causal factors that can trigger asthma?
Exposure to indoor and outdoor allergens and occupation sensitizers.
What are some contributing factors to asthma?
Respiratory infections, air pollution, active/passive smoking, and other factors like diet and small size at birth.
Who are the two parties involved in the Childhood Asthma Control Test?
The child and the parents.
How many people were estimated to be affected by asthma in 2019 according to WHO?
262 million people.
What are common symptoms of an early or mild asthma episode?
Dry cough, often occurring at night or early in the morning, and mild chest tightness.
What should you emphasize to the client regarding their emotional state?
The importance of remaining as calm as possible.
Who should be involved in creating a written asthma self-management action plan?
Patients, healthcare providers, and caregivers.
What should be encouraged to promote oxygenation if not contraindicated?
Ambulation.
How many times may you need to repeat the inhaler technique training?
2 - 3 times.
Do the features of asthma persist even when symptoms are absent?
Yes, they usually persist even when symptoms are absent or lung function is normal.
What key components should be included in an asthma self-management action plan?
Daily management strategies, medication usage, and emergency response actions.
What does GINA stand for?
Global Initiative for Asthma.
What do cyanosis, cool clammy skin, and changes in consciousness indicate?
Worsening hypoxia.
Which nursing diagnosis indicates problems with breathing?
Ineffective breathing pattern.
What is the most common non-communicable disease among children?
Asthma.
What is one non-pharmacological management strategy for asthma?
Weight reduction.
What is the recommended daily fluid intake to maintain adequate hydration?
1.5 to 2 liters per day.
What challenges contribute to asthma-related deaths in low-income countries?
Under-diagnosis and under-treatment.
What can severe asthma attacks lead to?
They may be life-threatening and require urgent admission to the hospital.
What should be considered when choosing an inhaler device before prescribing?
Medication options, available devices, patient skills, and cost.
What does pathophysiology study?
The functional changes that occur in the body as a result of a disease or medical condition.
In which non-asthma conditions can FeNO be elevated?
Eosinophilic bronchitis, atopy, allergic rhinitis, and eczema.
Who can provide highly effective inhaler skills training?
Pharmacists and nurses.
What is asthma usually associated with?
Airway hyperresponsiveness to stimuli and chronic airway inflammation.
What are the symptoms of asthma with obesity?
Prominent respiratory symptoms with little eosinophilic inflammation.
How does asthma affect the airways?
Asthma causes inflammation and narrowing of the airways, leading to difficulty in breathing.
What role do inflammatory cells play in asthma?
Inflammatory cells contribute to airway hyperresponsiveness and mucus production.
What does variable expiratory airflow limitation mean in the context of asthma?
It refers to airflow limitation that varies over time and may become persistent later in the disease course.
Are allergy tests specific to asthma?
No, they are not specific to asthma.
What year are the GINA guidelines being referenced?
What are some medication factors contributing to poor asthma adherence?
Difficulties using inhaler devices, burdensome regimens, and multiple different inhalers.
What terms are often used interchangeably with asthma exacerbations?
Episodes, attacks, acute severe asthma, and flare-ups.
What is a key symptom of cough variant asthma?
Cough may be the only symptom of asthma.
What is the purpose of the Childhood Asthma Control Test?
To assess symptom control in children with asthma.
What should you do to help a client relieve anxiety?
Stay with the client and encourage slow, deep breathing.
What is the purpose of controller medication in asthma management?
To reduce airway inflammation, control symptoms, and reduce future risks such as exacerbations and decline in lung function.
Why is it important to assess arterial blood gas results and pulse oximetry readings?
They provide information about gas exchange and the adequacy of alveolar ventilation.
What should you encourage the client to do regarding their feelings?
Encourage the expression of feelings.
What indicates a more confident diagnosis of asthma?
Excessive variability in expiratory lung function.
What relaxation technique can be taught to relieve anxiety?
Progressive muscle relaxation.
What does the Asthma Control Test assess?
It assesses symptom control in asthma patients.
What are some reasons for unintentional poor adherence in asthma treatment?
Misunderstanding instructions, forgetfulness, absence of a daily routine, and cost.
How often did asthma keep you from getting things done in the past 4 weeks?
Responses range from 'All of the time' to 'None of the time'.
What are some intentional factors that lead to poor adherence to asthma treatment?
Perception that treatment is unnecessary, denial or anger about asthma, inappropriate expectations, concerns about side effects, dissatisfaction with healthcare providers, stigmatization, cultural or religious issues, and cost.
What should be done if there is continuing deterioration in an asthma patient?
Treat as severe and reassess for ICU.
How many questions are included in the Asthma Control Test?
5 questions (4 symptom + 1 self-assessed control).
Which organizations provided data on asthma prevalence in Hong Kong?
Census and Statistics Department, Hospital Authority, and Department of Health.
What will students be able to state regarding asthma?
The definition and pathophysiology of asthma.
Is the narrowing of the airway in asthma reversible?
Usually, but in some clients with chronic asthma, it may lead to irreversible obstruction.
What are the common respiratory symptoms associated with asthma?
Wheeze, shortness of breath, chest tightness, and cough.
What will students discuss regarding asthma management?
The investigation and clinical management plan for asthma.
What is the purpose of the GINA guidelines?
To provide a comprehensive approach to asthma management.
What does a chest X-ray usually reveal in an acute asthma attack?
Usually clear; hyperinflation secondary to air trapping.
What symptoms indicate the need for ICU consultation in asthma management?
Drowsiness, confusion, silent chest.
In which types of countries do most asthma-related deaths occur?
Low- and lower-middle income countries.
What should be assessed regarding cough effort?
Cough effort and sputum for color, consistency, and amount.
How does allergic asthma respond to ICS treatment?
It responds well to ICS treatment.
When should a clinician consider stepping down asthma medication?
When asthma symptoms have been well controlled and lung function has been stable for 3 or more months.
What impact does asthma have on families and communities?
Missed school and work, leading to financial impact.
What should be administered as ordered to reduce hypoxaemia?
Oxygen.
How can emotional stress impact asthma management?
Dealing with emotional stress is important for asthma management.
What is a bronchial provocation test used for?
To assess lung function variability.
What is the FeNO level in T2-Low Asthma?
It is not elevated in T2-Low Asthma.
What are common triggers for asthma exacerbations?
Viral respiratory infections, allergen exposure, food allergy, outdoor air pollution, seasonal changes, and poor adherence with ICS.
What should be followed when using a nebulizer?
Infection control measures.
What will students learn to differentiate in this lecture?
The different types of asthma.
Why is peak flow monitoring important if symptoms appear excessive?
To assist in identifying occupational or domestic triggers for worsening asthma control.
How can a written asthma action plan benefit patients?
It provides clear instructions for managing asthma symptoms and helps prevent exacerbations.
What are common respiratory symptoms that may indicate asthma?
Wheeze, shortness of breath, chest tightness, and cough.
What factors can trigger variations in asthma symptoms?
Exercise, allergen or irritant exposure, change in weather, or viral respiratory infections.
How do asthma symptoms vary over time?
They occur variably over time and vary in intensity.
What is an early indicator of impaired gas exchange?
A fall in oxygen saturation levels.
When are asthma symptoms often worse?
At night or upon waking.
What type of exercise can help manage asthma non-pharmacologically?
Breathing exercises.
What is the appearance of sputum in pure asthma?
Clear, white, foamy, later becoming thicker and tenacious.
What is a benefit of using AIR compared to SABA relievers?
It reduces the risk of exacerbations.
How might a patient feel during an acute asthma episode?
Restless, apprehensive, and very anxious.
What factors should be considered when assessing a patient for asthma-related death?
Severity of exacerbation and worst features.
How can patient involvement be encouraged in choosing an inhaler device?
By allowing them to participate in the choice if different options are available.
What is one technique to improve lung function?
Deep breathing exercise.
What is the benefit of using a spacer with pMDIs?
It improves delivery and reduces potential side effects when using inhaled corticosteroids (ICS).
What are the long-term goals of asthma management?
Control of symptoms and risk reduction.
What is the average daily diurnal PEF variability for adults?
Greater than 10%.
What is the most frequent abnormality found during auscultation in asthma patients?
Expiratory wheezing (rhonchi).
What score range indicates well-controlled asthma?
Scores of 20 - 25.
What score range indicates not well-controlled asthma?
Scores of 16 - 19.
When might an artificial airway be indicated?
If indicated for the patient's condition.
What lung function goal should be maintained in asthma management?
Maintain normal lung function.
What is the purpose of a written asthma self-management action plan?
To help patients manage their asthma effectively by outlining steps to take during different situations.
What factors related to asthma will be described?
The precipitating factors and clinical manifestations of asthma.
Why is it important to explain procedures to the client?
To help them understand what to expect and reduce anxiety.
What does a positive skin test indicate?
It does NOT mean that the allergen is causing symptoms.
What nursing action may be necessary if a client cannot clear secretions by coughing?
Provide suctioning as needed.
Which nursing diagnosis reflects a patient's limited physical capability?
Decreased activity tolerance.
What does exhaled nitric oxide (FeNO) indicate in asthma diagnosis?
It is higher in asthma characterized by Type 2 (T2) airway inflammation.
What triggers asthma symptoms?
Exercise, laughter, allergens, and cold air.
Is exhaled nitric oxide (FeNO) specific to asthma?
No, it is not specific to asthma.
What is the goal of stepping down asthma medication?
To find the patient’s lowest treatment that controls both symptoms and exacerbations.
What is the potential impact of asthma exacerbations on patients?
They may be life-threatening and carry a significant burden.
What should be checked before considering a regimen with SABA reliever?
If the patient is likely to adhere to daily controller treatment.
What should individuals with asthma avoid regarding outdoor conditions?
Outdoor air pollutants and adverse weather conditions.
What indicates a severe asthma exacerbation?
Talks in words, sits hunched forward, agitated, respiratory rate >30/min, accessory muscles in use, pulse rate >120 bpm, O2 saturation <90%, PEF ≤50% predicted.
What may be absent in cough variant asthma apart from during bronchial provocation testing?
Evidence of variable airflow limitation.
What are the common inflammatory cells involved in asthma?
Eosinophils, mast cells, and T lymphocytes.
When might wheezing be absent in asthma patients?
During severe asthma exacerbations due to severely reduced airflow (silent chest).
What is pathophysiology?
The study of the functional changes that occur in the body as a result of a disease or medical condition.
What does the presence of atopy indicate in asthma patients?
It increases the probability that a patient with respiratory symptoms has allergic asthma.
What must be ruled out in cases of adult-onset asthma?
Occupational asthma.
What should patients do if their asthma symptoms worsen according to their action plan?
Follow the specific steps outlined for worsening symptoms, which may include using rescue medication or seeking medical help.
What happens during an asthma attack?
The airways become severely constricted, leading to wheezing, coughing, and shortness of breath.
What characterizes an exacerbation of asthma?
Episodes characterized by a progressive increase in symptoms like shortness of breath, cough, wheezing, or chest tightness, along with a decrease in lung function.
What is the rationale for suctioning in patients with ineffective airway clearance?
Suctioning may be necessary to remove secretions and improve ventilation.
What indicates excessive variability in expiratory lung function?
Evidence of significant changes in lung function measurements.
When can lung function tests be repeated if initially negative?
During symptoms or in the early morning.
What is one example of variation in lung function after bronchodilator administration?
An increase in lung function.
What should be avoided to reduce asthma triggers?
Occupational or domestic exposure to allergens.
What type of therapy should be administered as prescribed to promote oxygenation?
Oxygen therapy.
What type of medications should be avoided in asthma management?
Medications that may make asthma worse.
What is the importance of detailed history and examination in diagnosing asthma?
To determine if the history/examination supports the diagnosis of asthma.
How does asthma affect the airways?
Asthma causes inflammation and narrowing of the airways, leading to difficulty in breathing.
How often did asthma symptoms wake you up at night in the past 4 weeks?
Responses range from '4 or more nights a week' to 'Not at all'.
What is the recommended treatment for symptoms less than twice a month?
Use as-needed SABA.
What is PEF an abbreviation for?
Peak Expiratory Flow.
What are the signs of a life-threatening asthma exacerbation?
Drowsy, confused, or silent chest.
What environmental factor can trigger asthma symptoms?
Seasonal/climate changes, particularly cold air.
How can food allergies affect asthma?
Food allergies can trigger asthma exacerbations.
What action should be taken if PEF or FEV1 is less than 60% of the best?
Continue reliever, continue controller, add prednisolone 40-50 mg/day, and contact a doctor.
What type of strategies should be included in asthma management?
Non-pharmacological strategies.
What year did the Hospital Authority and Department of Health report on asthma prevalence in Hong Kong?
What is a nursing intervention for ineffective airway clearance?
Increase fluid intake to 2000 – 3000 mL if not contraindicated.
What is airway hyperresponsiveness?
An exaggerated response of the airways to various stimuli, common in asthma patients.
What indicates an acute onset of asthma symptoms?
Audible wheezing and shortness of breath.
What is the first step to ensure effective use of inhaler devices?
Show the patient how to use the device correctly with a physical demonstration, using a placebo inhaler.
What is a common method for conducting allergy tests?
Skin prick test.
What are the characteristics of mild or moderate asthma exacerbation?
Talks in phrases, prefers sitting, not agitated, increased respiratory rate, no accessory muscle use, pulse rate 100-200 bpm, oxygen saturation 90-95%, PEF >50% predicted.
What is the first step in managing a patient with an acute asthma exacerbation?
Assess the patient.
What nursing diagnosis indicates a lack of understanding or information?
Deficient knowledge.
Which nursing diagnosis pertains to a patient's ability to manage their health?
Ineffective health self-management.
What is the prevalence of asthma in the United States?
Data from the Institute for Health Metrics and Evaluation, 2019.
What should clinicians be able to demonstrate regarding inhalers?
Correct technique for each of the inhalers they prescribe.
When should suctioning be performed?
Whenever necessary.
What should be done before and after administering a bronchodilator?
Perform lung function test(s), e.g., spirometry or PEF.
What is often the result of a physical examination in people with asthma?
It is often normal.
What nursing intervention can assist with airway clearance?
Initiate or assist with chest physiotherapy, including percussion and postural drainage.
What dietary considerations should be made for asthma management?
Avoidance of certain foods and food chemicals.
What device can be used to encourage deep breathing and improve lung function?
Incentive spirometry.
How is asthma control rated in the Asthma Control Test?
From 'Not controlled at all' to 'Completely controlled'.
How is diurnal PEF variability calculated?
Using the formula: ([Day’s highest - day’s lowest]/mean of day’s highest and lowest) x 100.
How should asthma management affect exercise?
No exercise limitation.
What indicates an increase in lung function after anti-inflammatory treatment for adults?
An increase in FEV1 by ≥ 12% and ≥ 200 mL (or PEF by ≥ 20%) after 4 weeks of ICS-containing treatment.
What role does outdoor air pollution play in asthma?
Outdoor air pollution is a common trigger for asthma exacerbations.
What lung function characteristic is associated with Type 2 inflammation in asthma?
Higher blood eosinophils.
What should be done after increasing reliever and controller medications?
Review response to treatment.
What is the recommended dosage of prednisolone for adults in an asthma exacerbation?
40-50 mg.
What occupational exposure can be a risk factor for asthma?
Occupation-related chemicals.
Can the features of asthma normalize with treatment?
Yes, they may normalize with treatment.
Which patients are recommended to monitor peak flow long-term?
Patients who have difficult-to-control or severe asthma.
Why is increasing fluid intake important for patients with ineffective airway clearance?
It helps keep secretions thin.
What is a key feature in diagnosing asthma?
Confirmed variable expiratory airflow limitation.
What nursing diagnosis is associated with feelings of unease or worry?
Anxiety.
What characterizes allergic asthma?
Commences in childhood and is associated with a past and/or family history of allergic disease.
What is Box 1-1 in the GINA 2024 guidelines?
It typically summarizes key recommendations or concepts related to asthma management.
When should an alternative inhaler device be considered?
If the patient cannot use the inhaler correctly after several repeats of training.
What may ineffective cough signal?
Impending respiratory failure.
What treatments are recommended for severe asthma exacerbation?
SABA, ipratropium bromide, controlled oxygen, oral or IV corticosteroids, consider IV magnesium, consider high dose ICS.
What is a recommended strategy to manage asthma related to outdoor environments?
Avoidance of outdoor allergens.
What should be measured before and after bronchodilator administration?
Lung function tests such as spirometry or PEF.
What is the purpose of administering supplemental oxygen?
To reduce hypoxaemia.
What is the first step in the asthma management cycle?
Confirmation of diagnosis if necessary.
What should be documented before stepping down asthma medication?
The asthma status and clear instructions for the patient.
Name two countries mentioned with asthma prevalence data.
Australia and Sweden.
What should be provided to the patient during the stepping down process?
A written asthma action plan and sufficient medication to resume the previous dose if necessary.
What other tests are used alongside FeNO in asthma diagnosis?
Levels of eosinophils in sputum and blood.
What is the minimum increase in FEV1 or FVC for adults to confirm bronchodilator responsiveness?
≥ 12% and ≥ 200 mL.
What percentage of all deaths does asthma account for?
Less than 1%.
What role do patient preferences play in asthma management?
They guide treatment goals and strategies.
What tests should be performed to confirm variable expiratory airflow limitation?
Lung function tests, e.g., spirometry or PEF before and after bronchodilator.
What indicates an increase in lung function after anti-inflammatory treatment for children?
An increase in FEV1 of ≥ 12% predicted (or in PEF of 15%).
What exacerbation history is a risk factor for poor asthma outcomes?
Ever intubated or in intensive care unit for asthma, or ≥ 1 severe exacerbation in the last 12 months.
What is the preferred reliever medication recommended by GINA for adults and adolescents?
ICS-formoterol.
How does using ICS-formoterol as a reliever compare to using a SABA?
It reduces the risk of exacerbations and is a simpler regimen.
What contributes to airway remodeling in asthma?
Thickening of airway walls due to fibrosis and increased muscle thickness.
How does the Global Initiative for Asthma (GINA) define asthma?
Asthma is a heterogeneous disease characterized by chronic airway inflammation and a history of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and intensity.
What should be monitored to assess ineffective airway clearance?
Skin color, temperature, and level of consciousness.
What is a common nursing diagnosis related to airway issues?
Ineffective airway clearance.
What type of medication is used for as-needed relief of breakthrough asthma symptoms?
Reliever medication.
What is a key characteristic of asthma as defined by GINA?
Chronic airway inflammation.
What does Anti-Inflammatory Reliever (AIR) include?
ICS-formoterol and ICS-SABA.
How long can asthma symptoms sometimes be absent?
For weeks or months at a time.
What are the characteristics of severe asthma exacerbation?
Talks in words, sits hunched forward, agitated, respiratory rate >30/min, accessory muscles used, pulse rate >120 bpm, oxygen saturation <90%, PEF ≤50% predicted.
How do viral infections affect asthma symptoms?
Symptoms often appear or worsen with viral infections.
Which demographic has a higher prevalence of asthma among those under 18 years?
Boys aged <18 years.
What frequency of shortness of breath indicates poor asthma control?
More than once a day.
Which group has a higher prevalence of asthma among adults?
Women aged ≥18 years.
What is the scoring range of the Asthma Control Test?
5 to 25, with higher scores indicating better control.
What types of medications should be administered to promote oxygenation?
Bronchodilators, anti-inflammatory drugs, expectorants, and cough suppressants as prescribed.
What does frequent use of a rescue inhaler indicate?
It may indicate poorly controlled asthma.
What does variation in lung function beyond the normal range suggest?
Possible asthma or other respiratory conditions.
What is considered excessive variation in lung function for adults?
Variation in FEV1 of ≥12% and ≥200 mL or in PEF of ≥20% between visits.
What is a feasible and safe approach for stepping down ICS dose?
Stepping down by 25-40% at 3-month intervals for most patients.
What should all patients do during early or mild asthma exacerbations?
Increase reliever and early increase in controller medication.
What should be treated alongside asthma?
Modifiable risk factors and comorbidities.
What cellular components are involved in cellular infiltration during asthma?
Neutrophils, lymphocytes, and eosinophils.
What is necessary to support the diagnosis of asthma?
A detailed history and examination.
How long should a SABA be withheld before testing for bronchodilator responsiveness?
≥ 4 hours.
What is a vital goal to prevent in asthma management?
Prevent asthma deaths.
What is the maintenance treatment for step 3?
Low-dose maintenance ICS-formoterol.
What is the initial assessment for worsening asthma in the emergency department?
A: airway, B: breathing, C: circulation.
How may asthma symptoms and airflow limitation resolve?
Spontaneously or in response to medication.
What does an increased eosinophil count in a complete blood count indicate?
Allergic asthma.
What are some recommended positions for promoting oxygenation?
Semi-Fowler’s, High-Fowler’s, orthopneic position, and tripod position.
How often should inhaler technique be re-checked after initial training?
Frequently, as errors often recur within 4 - 6 weeks.
What are episodic flare-ups of asthma called?
Exacerbations.
What happens to lung function after exercise in some patients?
A decrease in lung function.
What can asthma lead to in the most severe cases?
Death.
What indoor factors should be avoided to manage asthma?
Indoor allergens.
What type of exposure can increase the risk of poor asthma outcomes?
Allergy exposure of sensitized individuals.
Which viral infections are known to trigger asthma exacerbations?
Rhinovirus, influenza, adenovirus, pertussis, and RSV.
Why is inhaler technique important in asthma management?
It ensures proper medication delivery and adherence.
How does air quality affect asthma?
Air pollution and high pollen counts can trigger asthma symptoms.
What are the characteristics of mild or moderate asthma exacerbation?
Talks in phrases, prefers sitting to lying, not agitated, increased respiratory rate, no accessory muscle use, pulse rate 100-200 bpm, oxygen saturation 90-95% (room air), PEF >50% predicted or best.
What is the recommended dosage of prednisolone for severe asthma exacerbations?
40-50 mg/day.
What are the signs of mild to moderate asthma exacerbation?
Talks in phrases, prefers sitting, respiratory rate increased, pulse rate 100-120 bpm, O2 saturation 90-95%, PEF >50% predicted.
What is the impact of poor adherence with ICS on asthma?
Poor adherence with ICS can lead to worsening asthma and exacerbations.
What additional treatments may be considered for severe asthma exacerbation?
IV corticosteroids, IV magnesium, high dose ICS.
What are the effects of bronchospasm in asthma?
Airway obstruction and difficulty breathing.
What should be reviewed during the follow-up visit?
Symptoms and signs to determine if the exacerbation is resolving and whether prednisone should be continued.
What physical signs may accompany acute asthma symptoms?
Cyanosis, sweating, and tachycardia.
What is a key non-pharmacological management strategy for asthma?
Cessation of smoking and environmental tobacco smoke exposure.
What position should a patient be placed in to facilitate breathing and lung expansion?
Fowler’s, high-Fowler’s, or orthopneic position.
How does physical activity contribute to asthma management?
It helps improve overall lung function and health.
What tests are performed to diagnose asthma?
Lung function tests, e.g., spirometry or Peak Expiratory Flow (PEF).
What does sputum examination reveal in asthma with infection?
Purulent greenish or yellow sputum.
What is a common respiratory effort observed in acute asthma episodes?
Use of accessory muscles for breathing.
What is a key feature for diagnosing variable expiratory airflow limitation?
Excessive variability in twice-daily PEF over 2 weeks.
What is a significant risk factor for poor asthma outcomes related to substance use?
Smoking and e-cigarettes.
What technique involves exhaling forcefully to clear airways?
Forced expiratory technique.
What should be controlled in asthma management?
Symptoms and modifiable risk factors.
How do percussion and postural drainage help patients?
They facilitate the movement of secretions and airway clearance.
What is a significant factor in assessing asthma risk related to genetics?
Positive family history of asthma.
What should asthma management aim to prevent regarding sleep?
No sleep disturbance.
What increase in PEF indicates a positive bronchodilator responsiveness test?
≥ 20%, if spirometry is not available.
What contributes to many asthma deaths?
Avoidable factors.
What is the treatment for daily symptoms or low lung function?
Consider high dose maintenance ICS - LABA, possibly with add-on therapies.
What is a critical prevention goal in asthma management?
Prevent exacerbations.
Which type of blood test results may indicate asthma?
Elevated eosinophils and elevated IgE levels.
What is the recommended dosage of salbutamol for the bronchodilator responsiveness test?
200 - 400 mcg.
What is a consequence of autonomic dysregulation in asthma?
Release of toxic neuropeptides.
When should the response to SABA be assessed?
At 1 hour (or earlier).
What should be done for patients with severe asthma exacerbation who are not improving?
Continue treatment and reassess frequently.
What can inadequate prescription of ICS lead to?
Increased risk of poor asthma outcomes.
What should be assessed regarding the asthma action plan during follow-up?
Whether it is understood, used appropriately, and if it needs modification.
How does AIR provide symptom relief?
It provides rapid symptom relief along with a small dose of ICS.
What happens to the cough during an acute asthma episode?
The cough becomes productive with mucoid sputum.
What is the rationale for placing a patient in Fowler’s position?
These positions reduce the work of breathing and increase lung expansion.
What does the Asthma Control Test assess?
Symptom control in asthma patients.
Why is it important to encourage frequent changes in position?
To promote better oxygenation.
How does non-allergic asthma respond to ICS treatment?
It demonstrates a lesser short-term response to ICS.
Which country has asthma prevalence data reported alongside the United States?
United Kingdom.
What is a positive bronchial challenge test for adults?
A fall from baseline in FEV1 of ≥20% with methacholine, ≥15% with hyperventilation, hypertonic saline, or mannitol challenge, or >10% and >200mL with exercise challenge.
Why is PEF considered less reliable than spirometry?
Because it may not provide as accurate a measure of lung function.
What is a key feature in diagnosing variable expiratory airflow limitation?
Positive bronchodilator responsiveness test with spirometry or PEF.
How many deaths does asthma account for worldwide each year?
Approximately 420,000 deaths.
What is the first step for patients with symptoms twice a month or more?
Low dose maintenance ICS.
What breathing technique focuses on using the diaphragm?
Diaphragmatic breathing technique.
What is the excessive variation in lung function for children?
Variation in FEV1 of ≥12% or ≥15% in PEF between visits.
What score range indicates very poorly controlled asthma?
Scores of 5 - 15.
What should be assessed in patients with chronic or recurrent respiratory symptoms?
Whether the symptoms are typical of asthma.
When should lung function tests be performed in relation to bronchodilator administration?
Before and after bronchodilator use.
What initial treatments are recommended for severe asthma exacerbation?
SABA, consider ipratropium bromide, controlled oxygen to maintain saturation 93-95% (children 94-98%), oral corticosteroids.
What are the signs of a life-threatening asthma exacerbation?
Drowsy, confused, or silent chest.
What type of asthma can be induced by medications?
Drug-induced asthma.
How should SABA be administered during an asthma exacerbation?
4-10 puffs by pMDI + spacer, repeat every 20 minutes for 1 hour.
What should be avoided to reduce asthma symptoms related to indoor environments?
Indoor air pollution.
What distinguishes non-allergic asthma from allergic asthma?
Non-allergic asthma is not associated with allergy.
What tests can be performed to assess lung function?
Spirometry or Peak Expiratory Flow (PEF).
What does a change in symptoms and lung function indicate in asthma patients?
It indicates a need for a change in treatment.
What factors should be considered when choosing the appropriate time to step down medication?
No respiratory infection, not traveling, and not pregnant.
What dietary approach can benefit asthma patients?
Maintaining a healthy diet.
What is a key component of effective asthma self-management education?
Self-monitoring of symptoms and/or lung function.
What role do bronchial hyperresponsiveness play in asthma?
It leads to exaggerated airway constriction in response to various stimuli.
What is the purpose of pursed-lip breathing?
To help control breathing and improve oxygenation.
How should symptoms be monitored during the stepping down process?
By monitoring symptoms and/or Peak Expiratory Flow (PEF), and scheduling a follow-up.
What should be done to ensure proper inhaler technique?
Check technique at every opportunity and ask the patient to demonstrate their use of the inhaler.
What should be done if symptoms occur most days or waking with asthma once a week?
Increase to low dose maintenance ICS - LABA.
What exercise can help clear mucus from the lungs?
Coughing exercise.
How long should the response to treatment be assessed?
At 1 hour or earlier.
How do seasonal changes affect asthma?
Seasonal changes can trigger asthma exacerbations.
Which interleukins are involved in immune activation in asthma?
IL-4, IL-5, IL-8, IL-13, IL-17, and IgE production.
What viral condition can contribute to asthma?
Viral infections.
What is a key aspect of patient satisfaction in asthma management?
Addressing comorbidities and treatment preferences.
What is the first step in managing worsening asthma?
Continue treatment with SABA as needed.
What is a specific allergic condition that can affect asthma patients?
Allergic bronchopulmonary aspergillosis.
What should be added in step 5 if symptoms persist?
Add-on LAMA and consider high-dose maintenance ICS-formoterol.
How does poor adherence affect asthma management?
It is a risk factor for poor asthma outcomes.
What adjustments may be made to the reliever and controller medications during follow-up?
Reduce reliever to as-needed and continue higher dose of controller for short or long term, depending on the exacerbation background.
How does pregnancy affect asthma management?
It is considered a risk factor for poor asthma outcomes.
What are the characteristics of a mild to moderate asthma exacerbation?
Talks in phrases, prefers sitting, not agitated, increased respiratory rate, no accessory muscle use, pulse rate 100-120 bpm, O2 saturation 90-95%, PEF >50% predicted.
What does spirometry help confirm in asthma diagnosis?
Variable expiratory airflow limitation.
Where is the current asthma prevalence highest?
In areas with the lowest annual household income.
What physical barriers should be checked to ensure effective inhaler use?
Conditions like arthritis that may limit the use of the inhaler.
What should be included in a written asthma action plan?
Instructions for managing worsening asthma and exacerbations.
What year is the asthma prevalence data from the Institute for Health Metrics and Evaluation?
How often should patients have a medical review for asthma management?
Regularly.
What is the result of airway remodeling in chronic asthma?
Permanent changes in the airway structure, leading to persistent symptoms.
What are vasoactive mediators involved in?
They play a role in vasodilation and increased capillary permeability.
What is the initial treatment for worsening asthma?
SABA (Short-Acting Beta Agonist) as needed.
What triggers immune activation in asthma?
Allergen or irritant exposure.
What should be checked before considering any step up in treatment?
Common problems like inhaler technique, adherence, allergen exposure, and comorbidities.
What characterizes a severe asthma exacerbation?
Talks in words, sits hunched forward, respiratory rate >30/min, pulse rate >120 bpm, O2 saturation <90%, PEF ≤50% predicted.
What gastrointestinal condition is associated with asthma?
Gastroesophageal reflux disease.
What is the recommended reliever dosage for steps 1-2?
As-needed low-dose ICS-formoterol.
What is the target oxygen saturation for controlled oxygen therapy?
93-95% for adults, 94-98% for children.
What is impaired mucociliary function associated with?
Increased mucus secretion and airway obstruction.
How can lung function variation be monitored over time?
Through separate visits or home monitoring over at least 1-2 weeks.
What is one goal related to asthma symptoms?
Few asthma symptoms.
What is the average daily diurnal PEF variability for children?
Greater than 13%.
How does air quality affect asthma outcomes?
Air pollution exposures are a risk factor for poor asthma outcomes.
Which European country is mentioned in the asthma prevalence data?
Portugal.
How can errors in inhaler use be identified?
By using a device-specific checklist.
What techniques can be performed to aid in lung clearance?
Percussion, vibration, and postural drainage.
What is essential for effective asthma education?
Skills training for patients and caregivers.
What type of reactions can worsen asthma symptoms?
Allergic reactions.
What should be assessed before considering a step up in treatment?
Inhaler technique, adherence, persistent allergen exposure, and comorbidities.
What is the impact of incorrect inhaler technique on asthma?
It can lead to poor asthma outcomes.
What indicates a positive bronchial challenge test for children?
A fall from baseline in FEV1 of >12% predicted or a fall in PEF >15% with standardized exercise challenge.
Why should the use of multiple different inhaler types be avoided?
To prevent confusion for the patient.
What types of allergens can trigger asthma exacerbations?
Grass pollen, soybean dust, and fungal spores.
What other signs are usually present when wheezing is absent during severe asthma exacerbations?
Other physical signs of respiratory failure.
What lung function measurement indicates a risk for poor asthma outcomes?
Low FEV1, especially <60% predicted.
What are common allergens that can exacerbate asthma?
Mold and pet dander.
What test result indicates a risk factor in adults with allergic asthma taking ICS?
Elevated FeNO.
What should be done while waiting for transfer to an acute care facility?
Give SABA, ipratropium bromide, O2, and systemic corticosteroid.
What indicates a need for discharge planning in moderate asthma exacerbation?
FEV1 or PEF <60% of predicted or personal best, or lack of clinical response.
What is a risk factor for poor asthma outcomes related to SBAB use?
High SBAB use (≥ 3 x 200-dose canisters/year) is associated with increased risk of exacerbations and mortality.
What may be needed for patients with severely uncontrolled asthma?
A short course of OCS.
What socioeconomic factor can impact asthma management?
Major psychological or socioeconomic problems.
What is the required increase in FEV1 for children to confirm bronchodilator responsiveness?
≥ 12% predicted (or in PEF of ≥15%).
Why is it important to clarify symptoms in the Asthma Control Test?
To ensure symptoms are due to asthma.
What are the signs of severe asthma exacerbation?
Talks in words, sits hunched forward, agitated, respiratory rate >30/min, accessory muscles being used, pulse rate >120 bpm, oxygen saturation <90% (room air), PEF ≤50% predicted or best.
What lung function tests should be performed to confirm variable expiratory airflow limitation?
Spirometry or PEF before and after bronchodilator.
What should be monitored in asthma management?
Symptoms, exacerbations, side effects, and lung function.
How often should clinical progress be assessed in patients with asthma exacerbation?
Frequently.
What is bronchial hyperresponsiveness?
Increased contractile response of bronchial smooth muscle.
What medical condition is associated with poor asthma outcomes?
Obesity.
What role do confirmed food allergies play in asthma?
They are a risk factor for poor asthma outcomes.
What additional treatments may be needed for severely uncontrolled asthma?
Short course OCS may also be needed.
What occurs during mast cell degranulation?
Release of inflammatory mediators that contribute to asthma symptoms.
What is the significance of withholding long-acting bronchodilators before the test?
It increases the likelihood of a positive test result.
What lung function measurements should be taken one hour after initial treatment?
FEV1 or PEF 60-80% of predicted or personal best and symptoms improved.
What should be arranged at discharge for asthma management?
Continue reliever as needed, start or step up controller, check inhaler technique and adherence, and continue prednisolone for 5-7 days.
What is the role of anti-inflammatory relievers in asthma management?
Used in Steps 3 - 5 for better control.
What should be minimized in asthma management?
Medication side effects, including OCS.
What is the follow-up timeframe for asthma management after discharge?
Within 2-7 days (1-2 days for children).
Which chronic condition is a risk factor for poor asthma outcomes?
Chronic rhinosinusitis.
What criteria indicate a patient can be discharged after an asthma exacerbation?
Symptoms improved, not needing SABA, PEF >60-80% of personal best, oxygen saturation >94% on room air, and adequate resources at home.
What should be checked and corrected regarding risk factors during follow-up?
Modifiable risk factors that may have contributed to the exacerbation, including inhaler technique and adherence.
What food-related factor can trigger asthma symptoms?
Certain food allergies.
What does AIR stand for in asthma management?
Anti-inflammatory reliever.
How can side effects of medications influence asthma management?
They can contribute to poor asthma outcomes.
How does gastroesophageal reflux disease (GERD) relate to asthma?
It is a risk factor for poor asthma outcomes.
