NURS 5433 Respiratory Exam Study Guide
I. Asthma
Stepwise Approach for Managing Asthma
Step 1: As-needed low-dose inhaled corticosteroid (ICS)-formoterol.
Step 2: Daily low-dose ICS or as-needed low-dose ICS-formoterol.
Step 3: Low-dose ICS-LABA (long-acting beta-agonist).
Step 4: Medium-dose ICS-LABA.
Step 5: High-dose ICS-LABA and consider add-on treatment (e.g., tiotropium,
biologics).
When to Step Up and Step Down
● Step Up: If asthma is not well-controlled (e.g., frequent symptoms, nighttime
awakenings, increased use of rescue inhaler).
● Step Down: If asthma is well-controlled for at least 3 months, consider
reducing medication to the lowest effective dose.
Asthma Action Plan (American Lung Association)
1. Green Zone: Doing well (80-100% of personal best peak flow).
2. Yellow Zone: Caution (50-79% of personal best); may need to increase
medication.
3. Red Zone: Medical alert (<50% of personal best); seek medical attention.
Differentiating Asthma and COPD
Asthma: Reversible airway obstruction, often with a history of allergies.
, COPD: Irreversible airway obstruction, often related to smoking history.
Pathophysiology of Asthma
Chronic inflammation of the airways, leading to bronchoconstriction, airway
hyperresponsiveness, and mucus production.
Presenting Signs & Symptoms:Wheezing, shortness of breath, chest tightness,
and cough, especially at night or early morning.
Physical Exam Findings
Wheezing on auscultation, prolonged expiration, possible use of accessory
muscles.
Diagnostics
● Spirometry showing reversible airway obstruction (improvement in FEV1
after bronchodilator).
● Peak flow monitoring.
Differential Diagnoses
COPD, vocal cord dysfunction, heart failure, bronchitis, GERD.
Protocols for Peak Flow Meters
Measure peak flow daily; compare to personal best.
1. Green Zone: 80-100% of personal best.
2. Yellow Zone: 50-79% of personal best.
3. Red Zone: <50% of personal best.
I. Asthma
Stepwise Approach for Managing Asthma
Step 1: As-needed low-dose inhaled corticosteroid (ICS)-formoterol.
Step 2: Daily low-dose ICS or as-needed low-dose ICS-formoterol.
Step 3: Low-dose ICS-LABA (long-acting beta-agonist).
Step 4: Medium-dose ICS-LABA.
Step 5: High-dose ICS-LABA and consider add-on treatment (e.g., tiotropium,
biologics).
When to Step Up and Step Down
● Step Up: If asthma is not well-controlled (e.g., frequent symptoms, nighttime
awakenings, increased use of rescue inhaler).
● Step Down: If asthma is well-controlled for at least 3 months, consider
reducing medication to the lowest effective dose.
Asthma Action Plan (American Lung Association)
1. Green Zone: Doing well (80-100% of personal best peak flow).
2. Yellow Zone: Caution (50-79% of personal best); may need to increase
medication.
3. Red Zone: Medical alert (<50% of personal best); seek medical attention.
Differentiating Asthma and COPD
Asthma: Reversible airway obstruction, often with a history of allergies.
, COPD: Irreversible airway obstruction, often related to smoking history.
Pathophysiology of Asthma
Chronic inflammation of the airways, leading to bronchoconstriction, airway
hyperresponsiveness, and mucus production.
Presenting Signs & Symptoms:Wheezing, shortness of breath, chest tightness,
and cough, especially at night or early morning.
Physical Exam Findings
Wheezing on auscultation, prolonged expiration, possible use of accessory
muscles.
Diagnostics
● Spirometry showing reversible airway obstruction (improvement in FEV1
after bronchodilator).
● Peak flow monitoring.
Differential Diagnoses
COPD, vocal cord dysfunction, heart failure, bronchitis, GERD.
Protocols for Peak Flow Meters
Measure peak flow daily; compare to personal best.
1. Green Zone: 80-100% of personal best.
2. Yellow Zone: 50-79% of personal best.
3. Red Zone: <50% of personal best.
