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Respiratory > 1(E); Asthma > Flashcards

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

A

PEF

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
Q

Explain direct challenge test

A

Individual is given inhaled histamine or methacholine and FEV1 recorded

26
Q

How is result recorded

A

Concentration requires to cause a 20% reduction in FEV1

27
Q

What is a positive test for direct challenge test

A

Concentration less-than 8

28
Q

What is the exercise challenge test

A

Drop in 15% of FEV1 in response to exercise

29
Q

What is exercise challenge test also known as

A

Indirect challenge test

30
Q

What chemical can also be used in indirect challenge test

A

Mannitol

31
Q

Why is direct challenge test used preferentially to indirect challenge test

A

More sensitive

32
Q

What is third-line test for asthma

A

FeNO

33
Q

What does a negative fraction exhaled NO test mean

A

Does not exclude diagnosis of asthma

34
Q

What is a positive FeNO test result

A

> 40 ppb

35
Q

In diagnosis of asthma what is first line

A

Clinical assessment:

  • Cough
  • Episodic symptoms
  • Wheeze
  • Atopy

Is used to divide individuals into high and intermediate probability

36
Q

If a high probability of asthma, what is done

A

Trial 6W inhaled corticosteroids.

37
Q

After 6W inhaled corticosteroid trial what is done

A

Assess symptoms using PEF and spirometry

38
Q

If intermediate probability what is done

A
  • 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
Q

What are individuals typically prescribed for asthma

A

Maintenance and reliever therapy

40
Q

What is reliever therapy usually

A

SABA

41
Q

Explain what is first-step in asthma management pathway for adults

A

SABA

42
Q

What is second step in asthma pathway for adults

A

Low dose ICS (100mcg 2 puffs daily)

43
Q

What is third step in asthma pathway for adults

A

Add LABA

44
Q

What is fourth-step in asthma pathway for adults

A

Increase ICS (200mcg) or add LTRA

45
Q

What is firth step in asthma management

A

Refer to specialist - may add high dose corticosteroid, tiotropium or theophylline

46
Q

Explain management of asthma in pregnant women

A

Same management as non-pregnant women

Respiratory (19 decks)

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