ASTHMA

LEARNING OBJECTIVES:

KNOWLEDGE - Students should be able to describe and define:

1. Discuss the etiology, pathophysiology, and pathology of asthma.
2. Discuss the epidemiology, risk factors, symptoms, signs, and typical clinical course of asthma.
3. Prioritize common causes of acute exacerbations of asthma, allergic and non-allergic, including:
   1. Acute infectious bronchitis
   2. Pneumonia
   3. Pulmonary edema
   4. Poor air quality (e.g. ozone, pollutants, tobacco smoke)
   5. Occupational exposures
   6. Medical noncompliance
   7. Grass and tree pollen
   8. Animal dander
   9. Cockroaches
   10. Dust mites
   11. Allergic rhinitis/post-nasal drip
   12. Acute/chronic infectious sinusitis
   13. Exercise
   14. Anxiety/stress
   15. Smoking
4. Discuss the etiology, pathogenesis, evaluation and management of hypoxemia and hypercapnia in the context of asthma.
5. Discuss therapies for asthma, noting side effects, advantages, disadvantages, and side effects, for the following:
   1. Beta-agonist bronchodilators
   2. Anticholinergic bronchodilators
   3. Leukotriene inhibitors
   4. Mast cell stabilizers
   5. Theophylline
   6. Inhaled corticosteroids
   7. Systemic corticosteroids
   8. Antimicrobial agents
   9. Supplemental oxygen
   10. Immunotherapy
6. Identify the indications for and the efficacy of influenza and pneumococcal vaccines.

SKILLS - Students should demonstrate specific skills, including:

1. History-taking: Students should be able to obtain, document, and present an age-appropriate medical history, including duration and severity of shortness of breath, sputum production, cough, wheezing, hemoptysis, fever, abnormal nocturnal/diurnal sleep patterns, patient's occupational history, including current and past exposures, environmental, smoking (active and passive).
2. Physical Exam: Students should be able to perform a physical exam to establish the diagnosis and severity of disease, including accurate assessment of the use of accessory muscles for breathing, accurate determination of pulsus paradox, and accurate recognition of abnormal breath sounds.
3. Differential Diagnosis: Students should be able to generate a differential diagnosis recognizing specific history and physical exam findings that confirm or refute a diagnosis of asthma, chronic bronchitis, or emphysema.
4. Laboratory Interpretation: Students should be able to recommend when to order and how to interpret a chest x-ray, spirometry, arterial blood gases, sputum gram stain, and pulse oximetry in the evaluation of patients suffering from obstructive airways disease.
5. Communication Skills: Students should be able to communicate the diagnosis, prognosis, and treatment plan of the disease to patients and their families.
6. Basic Procedural Skills: Students should be able to proficiently obtain arterial blood gas samples.
7. Management Skills: Students should be able to develop an appropriate management and treatment plan of patients with obstructive airways disease, demonstrating an understanding of the basic principles of oxygen, antibiotic, bronchodilator, and corticosteroid therapy, applying smoking cessation strategies where applicable, and recommending appropriate pneumovax and influenza vaccinations.
8. Computers in Medicine: Students should be able to efficiently search the literature to identify relevant, up to date information and practice guidelines related to the management of asthma and/or COPD.

ATTITUDES AND PROFESSIONAL BEHAVIORS

• Students should recognize that poor working, living, and environmental conditions can contribute to respiratory tract disease.

ASTHMA REFERENCES:

1. Asthma, Harrison's On-Line: http://harrisons.accessmedicine.com/server-java/Arknoid/amed/harrisons/co_chapters/ch252/ch252_p01.html .
2. National Asthma Education and Prevention Program Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm . (The full NHLBI report is quite extensive and takes about ten minutes to download and, as such, is only included as a reference for future use.)
3. The 2002 NHLBI summary review http://www.nhlbi.nih.gov/guidelines/asthma/index.htm