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1(E); Asthma Flashcards

1
Q

What is asthma

A

Chronic, reversible airway obstruction

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2
Q

In which patients is asthma more common

A

Afro-Carribean

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3
Q

In which gender is asthma more common under 18

A

Males

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4
Q

In which gender is asthma more common over 18

A

Females

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5
Q

How can triggers of asthma be divided

A
  • Intrinsic (allergic)

- Extrinsic

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6
Q

What are risk factors for extrinsic asthma

A
  • Pollen
  • Atopy
  • Dust-mite
  • Occupational asthma - floor dust
  • Mould Spores
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7
Q

What are triggers for intrinsic asthma

A
  • GORD
  • Cold air
  • Physical exertion
  • Chronic sinusitis
  • B Blockers
  • NSAIDs
  • Aspirin
  • Stress
  • Viral Infection
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8
Q

When is a viral infection a common trigger

A

Children

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9
Q

What is the main risk factor for asthma

A

Atopy: allergic rhinitis, eczema, asthma

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10
Q

What are the main symptoms of asthma

A
  • Dyspnoea
  • Nocturnal cough
  • Wheeze
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11
Q

When is the cough worse in asthma

A

Nocturnal

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12
Q

Explain signs of asthma on auscultation

A
  • Expiratory polyphonic wheeze

- Decrease air entry

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13
Q

Explain signs of asthma on percussion

A

Hyper resonant

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14
Q

What type hypersensitivity reaction is asthma

A

Type I

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15
Q

What is first line investigation in asthma

A

Spirometry and bronchodilator reversibility

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16
Q

What does a negative spirometry result mean

A

Does not exclude diagnosis of asthma - as asthma is variable over short periods of time

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17
Q

What spirometry defines asthma

A

FEV1/FVC <70%

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18
Q

What bronchodilator reversibility is a positive test

A

Improvement of more than 12% (200ml)

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19
Q

What bronchodilator reversibility strongly indicates asthma

A

Improvement of more than 400ml

20
Q

What is used to support diagnosis of asthma

21
Q

How long should PEF be measured across

A

2 weeks, at least 4 readings a day

22
Q

What PEF variability is positive for asthma

A

More than 20%

23
Q

What is used when considering a diagnosis of occupational asthma

A

PEF readings should be taken at work and away from work

24
Q

What is second-line investigation for asthma

A

Direct challenge test

25
Explain direct challenge test
Individual is given inhaled histamine or methacholine and FEV1 recorded
26
How is result recorded
Concentration requires to cause a 20% reduction in FEV1
27
What is a positive test for direct challenge test
Concentration less-than 8
28
What is the exercise challenge test
Drop in 15% of FEV1 in response to exercise
29
What is exercise challenge test also known as
Indirect challenge test
30
What chemical can also be used in indirect challenge test
Mannitol
31
Why is direct challenge test used preferentially to indirect challenge test
More sensitive
32
What is third-line test for asthma
FeNO
33
What does a negative fraction exhaled NO test mean
Does not exclude diagnosis of asthma
34
What is a positive FeNO test result
>40 ppb
35
In diagnosis of asthma what is first line
Clinical assessment: - Cough - Episodic symptoms - Wheeze - Atopy Is used to divide individuals into high and intermediate probability
36
If a high probability of asthma, what is done
Trial 6W inhaled corticosteroids.
37
After 6W inhaled corticosteroid trial what is done
Assess symptoms using PEF and spirometry
38
If intermediate probability what is done
- Assess lung function using PEF and spirometry - 6W corticosteroids - Assess lung function using PEF and spirometry If diagnosis not confirmed use additional tests including direct challenge test and FeNO
39
What are individuals typically prescribed for asthma
Maintenance and reliever therapy
40
What is reliever therapy usually
SABA
41
Explain what is first-step in asthma management pathway for adults
SABA
42
What is second step in asthma pathway for adults
Low dose ICS (100mcg 2 puffs daily)
43
What is third step in asthma pathway for adults
Add LABA
44
What is fourth-step in asthma pathway for adults
Increase ICS (200mcg) or add LTRA
45
What is firth step in asthma management
Refer to specialist - may add high dose corticosteroid, tiotropium or theophylline
46
Explain management of asthma in pregnant women
Same management as non-pregnant women

Respiratory (19 decks)

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