ASTHMA CHEAT SHEET
Asthma is: an obstructive pulmonary disease, resulting from hyper-responsiveness of the airway.
Inflammation of the airway causes smooth muscle contraction leading to bronchoconstriction. This
bronchoconstriction increases the work of breathing and causes distress. Inflammatory pathways and
sympathetic tone mediate the constriction.
Presenting symptoms often include: expiratory wheezing, cough, shortness of breath.
Triggers of asthma:
 Viral URIs
 Allergies
 Irritants
o Exercise, weather, dust, smoke
Ask about:
 Nocturnal coughing
 Albuterol use per day
 Symptoms per day
 Limited function because of
asthma
 Allergies (e.g. hayfever)
 Household pets
 Smoking
Physical Exam Findings May Include:
Vitals:
 Increased respiratory rate
o Stress response
o Increases minute volume
o combats acidosis (in
extreme cases)
HEENT:
 Nasal polyps
o if aspirin sensitivity
 Allergy signs
o e.g. “cobblestone throat”
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Family history of asthma
Medication compliance
Hospitalizations due to asthma
Previous corticosteroid
treatments for asthma
Intubations from asthma
Side effect of asthma meds
Lung exam:
 Expiratory wheezing (highpitched whistling sounds)
 Prolonged expiratory phase
 No air movement = emergency
Skin:
 Often associated with atopic
dermatitis / eczema (in
pediatrics)
Labs
Peak Flow measurements assess expiratory air flow.
- Calculated as % of predicted.
CXR shows hyperinflation (flattened diaphragm) during acute phase.
CXR is normal when asthma is controlled.
Sputum may show Charcot-Leyden crystals, Curschmann’s spirals.
Allergy-related asthma can be associated with eosinophils.
Revised 2/17/14. Email Justin.berk@ttuhsc.edu with any feedback.
Classification of Asthma
Intermittent
Mild
Moderate
Severe
Symptoms
<2 days / wk
>2 days/wk
Daily
Throughout day
Inhaler use
<2 days / wk
>2 days/wk
Daily
Multiple per day
Nighttime
awakening
1 / month
3 / month
1 / week
Every night
-
Minor
limitation
Some limitation
Extremely
limited
Normal
FEV1 < 80%
FEV1/FVC:
reduced 5%
FEV1 < 60%
FEV1/FVC:
reduced >5%
Activity
PFTs
Normal
*PFT = pulmonary function tests
Treatment Steps of Asthma
“Rescue inhaler” = short-acting Beta agonist = SABA = Albuterol
If SABA used >2 days a week, asthma is uncontrolled: Step Up treatment.
STEP
TREATMENT
EXAMPLE
NOTE
β- agonists decreases smooth muscle
#1
Rescue inhaler (SABA)
Albuterol
constriction
- Steroids decrease inflammation
Beclomethasone,
#1 + inhaled
(inactivate NF-KB)
#2
Fluticasone,
corticosteroid
- Instruct patient to brush teeth after
Budesonide
corticosteroid use to avoid thrush
Combination therapy:
#2 + Long b-agonist
Salmeterol,
#3
Advair (Fluticasone + Salmeterol),
(LABA)
formoterol
Symbicort (Budesonide + Formoterol)
#3 + Leukotriene
Can relieve symptoms of seasonal
#4
Montelukast
receptor antagonist
allergies
#5
#4 + Increase dose of corticosteroids. *
#6
Add oral corticosteroids
Prednisone
*Can also consider Omalizumab (anti-IgE) at Step 5, but it is very cost prohibitive
**Items in Red available at the Free Clinic.
Other USMLE asthma drugs include: theophylline (PDE-I), ipratropium (muscarinic
antagonists), cromolyn (blocks mast cell cytokines), Zileuton (5-LPO inhibitor).
Revised 2/17/14. Email Justin.berk@ttuhsc.edu with any feedback.