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PHRM 514 - Asthma - Fall 2012 (1)

Case n pmh eczema allergic rhinitis n fh mom age 34

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Case n PMH: Eczema, allergic rhinitis n FH: Mom, age 34, CEO, with allergic rhinitis; Dad, age 36, movie star, with asthma; 1 pet dog n Allergies: NKDA n Medications: fexofendadine 30mg PO twice daily and hydrocortisone 0.25% lotion, thin film applied twice daily PRN eczema n Immunizations: up to date
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What are the factors most likely influencing the development of asthma in this patient?
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Describe the most likely triggers for this patient’s asthma.
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What are the 3 main components of the pathophysiologic processes of asthma?
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Describe signs and symptoms of chronic asthma.
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What options are available to diagnose this patient?
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What questions could we ask this patient to help make a diagnosis?
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Sample Questions for the Diagnosis and Initial Assessment of Asthma n A “yes” answer to any question suggests that an asthma diagnosis is likely. n In the last 12 months… ¡ Have you had a sudden severe episode or recurrent episodes of coughing, wheezing (high-pitched whistling sounds when breathing out), chest tightness, or shortness of breath? ¡ Have you had colds that “go to the chest” or that take more than 10 days to get over? ¡ Have you had coughing, wheezing, or shortness of breath during a particular season or time of the year? ¡ Have you had coughing, wheezing, or shortness of breath in certain places or when exposed to certain things (e.g., animals, tobacco smoke, perfumes)? ¡ Have you used any medications that help you breathe better? How often? ¡ Are your symptoms relieved when the medications are used? n In the past four weeks, have you had coughing, wheezing, or shortness of breath… ¡ At night that has awakened you? ¡ Upon awakening? ¡ After running, moderate exercise, or other physical activity? Kell HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. Pharmacotherapy a pathophysiologic approach. 7th ed. New York: McGraw Hill Medical; 2008. P. 463-72.
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What changes would we expect to see with spirometry?
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List 3 airway cells involved in airway inflammation.
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May shed which may result in heightened airway responsiveness, altered permeability of the airway mucosa, and loss of enzymes responsible for breaking down proinflammatory mediators. 1. Eosinophils 2. Epithelial cells 3. Mast cells 4. Lymphocytes 5. Alveolar macrophages
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Once activated by an allergen via an IgE receptor, these cells initiate the release of histamine, chemotactic factors, leukotrienes, prostaglandins, and platelet activating factor 1. Eosinophils 2. Epithelial cells 3. Mast cells 4. Lymphocytes 5. Alveolar macrophages
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Increased in numbers in the airways of those with asthma and release inflammatory mediators such as leukotrienes and granule proteins to injure airway tissue 1. Eosinophils 2. Neutrophils 3. Fibroblasts 4. Alveolar macrophages 5. Mast cells
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High numbers found in the airways of patients who died from sudden onset fatal asthma and in those with severe disease, but role in asthma unclear.
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