Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Respiratory System (CA) > 29a. Asthma Management in Adults and Children > Flashcards

29a. Asthma Management in Adults and Children Flashcards

1
Q

What has an enormous effect on the flow resistance in the airways?

A

Radius (R^4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the prevalence of asthma in the UK?

A

~ 10% population (5.5m patients in UK)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What percentage of hospital admissions for asthma are avoidable?

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How many people die every six hours from Asthma?

A

One person every six hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What percentage of deaths are preventable?

A

90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a basic definition of Occupational asthma?

A

Symptoms related to work exposure

No prior history of Asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a basic definition of Work-exacerbated Asthma?

A

Symptoms related to work exposure

Prior history of Asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the investigations for Asthma?

A 
Peak flow monitoring
Spirometry 
Bronchodilator reversibility
Blood tests (Eosinophils, IgE)
Allergy tests (skin, blood)
Bronchial hyper-responsiveness
Exhaled NO
CXR in some patients
Challenge testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the two types of asthma?

A

Acute Asthma Attack

Chronic Asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the Non-pharma techniques for treating acute asthma attack?

A

ITU/HDU
Ventilation
ECCO2R
Chest drain if pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the main drug techniques for treating acute asthma attack?

A

Bronchodilator:
Oxygen
Magnesium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the main drug techniques for treating chronic asthma?

A

Anti-inflammatory:
Leukotriene RAs
Monoclonal Abs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the main drug techniques for treating both acute asthma attack and chronic asthma?

A 
Bronchodilators:
- β2 agonists
- Anti-muscarinics
- Theophyllines
Anti- inflammatory:
- Steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the Non-pharma techniques for treating chronic asthma?

A 
Asthma Action Plan
Weight loss if ˄BMI
Vaccines – flu & pneum
Allergen avoidance
     (inc. occup. Asthma)
Physiotherapy
Smoking Cessation
Bronchial Thermoplasty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What drugs should be avoided in asthma management?

A

β-blockers
NSAIDS / Aspirin
Sedatives/strong opiates (unless in critical care)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the main way of chronic asthma management and why?

A

Mainly inhalers

  • Small dose of drugs
  • Delivery directly to the target organ (airways and lung)
  • Onset of effect is faster
  • Minimal systemic exposure
  • Systemic adverse effects are less severe and less frequent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the facts about pMDI (Metered Dose Inhalers)?

A

DEVICE GENERATES AEROLSOL - low insp. flow
Needs co-ordination
Elderly, young children, unwell can’t use effectively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the facts about pMDI (Metered Dose Inhalers) with spacers?

A

Low oro-pharyngeal deposition of aerosol
Reduced speed of the aerosol
Decreases bad taste associated with oral deposition
Reduced the risk of oral candidiasis and dysphonia with steroids
Reduced “cold-Freon effect” in some

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the facts about Dry powder inhalers (DPI)?

A

PATIENT GENERATES AEROSOL – high insp flow
Less coordination required
Similar issues with deposition

20
Q

What is the complete control of Asthma defined as?

A 
No daytime symptoms 
No night-time awakening due to asthma 
No need for rescue medication 
No asthma attacks 
No limitations on activity including exercise & normal lung function (in practical terms FEV1 and/or PEF>80% predicted or best)
Minimal side effects from medication.
- BTS/SIGN 2016
21
Q

What are two Short acting beta 2 agonists (SABA) - Relievers?

A 
Salbutamol
- MDI
- DPI
Terbutaline
- DPI
22
Q

What are the adverse effects of Beta2-stimulants?

A 
Tremor 
Cramp
Headache
Flushing
Palpitations
Angina
23
Q

What are the inhaled coricosteroids (ICS) - Preventers?

A 
Beclomethasone
Budesonide
Fluticasone 
Ciclesonide
Mometasone
24
Q

When do you start ICS?

A

Using inhaled β2 agonist (“Reliever”) x3/week or more
Waking one night a week or more due to asthma
Requiring oral steroid for an exacerbation in the past 2 years
Symptomatic x3/week or more

25
Q

What are the the advantages of the inhaled route of corticosteroids?

A 
Low dose
Delivered to the site of action
Minimal side effects 
- No adrenal suppression 
- No bone problems
- Normal growth in children
26
Q

What are the long term steroid side effects taken orally?

A 
Red cheeks
Moon face
Fat pads (Buffalo hump)
Thin skin
High B.P.
Thin arms and legs
Osteoporosis 
Poor wound healing
Pendulous abdomen
Red Striation
Bruisability ecchymoses
27
Q

What are the long term steroid side effects that are inhaled?

A

Dysphonia

Oropharyngeal candidiasis

28
Q

What are the ICS + Long acting beta2 agonists (LABA)?

A 
Fostair (pMDI & DPI)
- Beclomethasone with formoterol
Symbicort (DPI)
- Budesonide with formoterol
DuoResp SpiroMax (DPI)
- Budesonide with formoterol
Flutiform (pMDI)
- Fluticasone propionate with formoterol
Seretide (pMDI & DPI)
- Fluticasone propionate with salmeterol
Relvar Ellipta (DPI)
- Fluticasone fumarate with vilanterol
29
Q

What are the LTRA (Leukotriene Receptor Agonists)?

A

Montelukast

Zafirlukast

30
Q

What are the facts about LTRAs?

A

More effective in those highly allergic
Response is difficult to predict
Worth a 6-12 week trial in some patients

31
Q

What are the facts about Theophylline?

A

Non-specific phosphodiesterase inhibitor and adenosine receptor antagonist
Weak bronchodilator
Narrow therapeutic window
Unpredictable metabolism- Interacts with many drugs

32
Q

What are the side effects of Theophylline?

A 
Anorexia
Headache
Nausea
Malaise
Vomiting
Nervousness
Abdominal discomfort
Insomnia
Tachycardia
Tachyarrhythmias
Convulsions
33
Q

What are the facts about Inhaled Long-acting Anti-muscarinic (LAMA)?

A

Tiotropium Bromide
- via Spiriva Respimat device
Antagonises M3 muscarinic Acetylcholine receptor in bronchial smooth muscle – some limited evidence of benefit in asthma when added to ICS/LABA

34
Q

What are the side effects of Inhaled Long-acting Anti-muscarinic (LAMA)?

A

Dry mouth
GI upset
Headaches
Can rarely precipitate angle-closure glaucoma (ophthalmological emergency)

35
Q

What are the facts about long-term oral steroids?

A

Prednisolone is main drug used
Aim for lowest oral dose that controls symptoms
Should have a “steroid alert card”

36
Q

What could happen after abrupt cessation of oral steroid if on long-term oral steroids for >3 weeks?

A

Acute Adrenal Insufficiency (failure of adrenal glands to produce endogenous glucocorticoid – can be fatal)

37
Q

What are the facts about Omalizumab (Anti- IgE)?

A

Monoclonal Antibody (mab) against IgE
IgE mediated severe allergic asthma
Usually started by Specialist centres (Difficult asthma clinics)

38
Q

What are the facts about Mepolizumab (Anti-Interleukin-5)?

A 
Monoclonal Antibody (mab) against Interleukin-5
Poor asthma control (long term steroid or frequent steroid) with blood eosinophilia
Usually started by Specialist centres (Difficult asthma clinics)
39
Q

What are other steroid sparing drugs and what is significant about them?

A

Immune suppressive drugs (more often used in conditions such as Rheumatoid Arthritis, and in organ transplant recipients), eg:
- Methotrexate
- Ciclosporin
- Oral Gold
These agents can have significant side effects and are often tried as a ‘last resort’

40
Q

What are the non-pharmacological solutions for asthma?

A 
Patient Education and Self management plans
Inhaler technique
Smoking cessation
Flu/Pneumococcal vaccinations
Co-morbidities
Obesity
Allergic Rhinitis
GORD
Stepping down treatment when controlled
Allergen avoidance
Bronchial Thermoplasty
41
Q

What is the solution for asthma in occupational asthma?

A

Prompt removal from inhalational exposure is the definitive cure

42
Q

What are the signs of moderate asthma?

A

Increasing symptoms
PEF >50-75% or predicted
No features of acute severe asthma

43
Q

What are the signs of acute severe asthma?

A 
Any one of:
PEF 33-55% best or predicted 
Respiratory rate >/= 25/min
Heart rate >/= 110/min
Inability to complete sentences in one breath
44
Q

What are the clinical signs of Life-threatening asthma?

A 
Altered conscious level
Exhaustion
Arrhythmia
Hypotension
Cyanosis
Silent chest
Poor respiratory effort
45
Q

What are measurements of Life-threatening asthma?

A

PEF <33% best or predicted
SpO2 <92%
PaO2 < 8 kPa
‘normal’ PaCO2 (4.6-6.0 kPa)

46
Q

What are the clinical signs of near-fatal asthma?

A

Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures

Respiratory System (CA) (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions