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ANKI Respiratory > [4] Asthma > Flashcards

[4] Asthma Flashcards

1
Q

What is asthma?

A

A common lung condition that causes occassional breathing difficulties due to reversible airway obstruction

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2
Q

What happens when an environmental trigger is breathed in in asthma?

A

A type 1 hypersensitivity reaction occurs involving Th2 cells

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3
Q

What happens when a type 1 hypersensitivity reaction occurs in asthma?

A

Acute narrowing of the airway, and the classic symptoms of wheezing

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4
Q

What leads to the acute narrowing of the airway in asthma?

A
  • Increased contractility of smooth muscle
  • Mucosal swelling/inflammation
  • Increased mucus production
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5
Q

What causes increased contractility of smooth muscle in asthma?

A

Chronic inflammation of the conducting zone of the airways, especially the bronchi and bronchioles

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6
Q

What causes mucosal swelling/inflammation in asthma?

A

Mast cell and basophil degranulation, resulting in the release of inflammation mediators

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7
Q

Is the narrowing reversible in asthma?

A

Yes, it is typically reversible with or without treatment, however occassionally the airways change

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8
Q

What long-term changes might occur in asthma?

A
  • Increased eosinophils
  • Thickening of the lamina reticularis
  • Changes in size of airway smooth msucle
  • Increase in number of mucous glands
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9
Q

What are the causes of asthma?

A

The exact cause of asthma is unknown, but several factors have been suggested as possible causes, including;

  • Modern hygiene standards
  • Air pollution
  • Chlorine in swimming pools
  • Genes
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10
Q

What are the risk factors for asthma?

A
  • Family history of asthma or related atopic conditions
  • Having another atopic condition yourself
  • Having bronchiolitis as a child
  • Exposure to tobacco smoke as a child
  • Mother smoking during pregnancy
  • Being born prematurely, or with a low birth weight
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11
Q

Give 3 examples of atopic conditions that might be associated with asthma

A
  • Eczema
  • Food allergy
  • Hay fever
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12
Q

What is bronchiolitis?

A

A common lower respiratory tract infection that affects babies and young children under the age of 2

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13
Q

How serious is bronchiolitis?

A

Most cases are mild, and clear up without the need for treatment within 2-3 weeks, although some children have severe symptoms and require hospitalisation

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14
Q

What causes bronchiolitis?

A

RSV, which causes the bronchioles to become inflamed, reducing air entry into the lungs and making it difficult to breathe

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15
Q

What are the early symptoms of bronchiolitis?

A

Those of a common cold, including runny nose and cough

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16
Q

What symptoms develop over a few days in bronchiolitis?

A
  • Fever
  • Dry and persistent cough
  • Difficulty feeding
  • Wheezing
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17
Q

Is there any effective anti-viral for bronchiolitis?

A

No

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18
Q

How is bronchiolitis treated?

A

Treatment is supporive, including ensuring sufficient fluid intake, and paracetamol or ibuprofen for pain relief

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19
Q

What occupations are at risk of asthma?

A
  • Paint sprayers
  • Bakers and pastry makers
  • Nurses
  • Chemical workers
  • Animal handlers
  • Welders
  • Food processing workers
  • Timber workers
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20
Q

What are the potential triggers for asthma?

A
  • Infections
  • Allergens
  • Airborne irritants
  • Medicines
  • Emotions
  • Food additives
  • Weather conditions
  • Mold or damp
  • Exercise
  • Food allergies
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21
Q

What infections in particular can trigger asthma?

A

Those of the upper airway

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22
Q

Give 3 example of allergens that can trigger asthma

A
  • Pollen
  • Dust mites
  • Animal fur
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23
Q

Give 3 airborne irritants that might trigger asthma

A
  • Cigarette smoke
  • Fumes
  • Pollution
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24
Q

What medicines in particular can trigger asthma?

A

NSAIDs

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25
Q

What food additives might trigger asthma?

A
  • Sulphites
  • Tartrazine
26
Q

What are the symptoms of asthma?

A
  • Wheezing
  • Breathlessness
  • Chest tightness
  • Coughing
27
Q

When are respiratory symptoms more likely to be caused by asthma?

A

If they happen often and keep coming back, are worse at night and early in the morning, and seem to occur in response to a triggee

28
Q

How is asthma investigated?

A
  • History and examination
  • Spirometry
  • Peak flow test
  • Airway responsiveness
  • Testing airway inflammation
  • Allergic testing
29
Q

What history features increase the likelihood of asthma?

A
  • Wheeze, SOB, and chest tightness
  • Diurnal variation
  • Response to exercise
  • History of atopy
  • Symptoms after aspirin or ß-blocker
30
Q

What history features decrease the likelihood of asthma?

A
  • Prominent dizziness, light headedness, or tingling
  • Chronic productive cough with no wheeze
  • Symptoms with cold only
  • Significant smoking history
  • Cardiac disease
31
Q

What are the examination features of asthma?

A
  • Tachypnoea
  • Audible wheeze
  • Hyperinflated chest
  • Hyper-resonant percussion note
  • Decreased air entry
  • Widespread polyphonic wheeze
32
Q

What are the signs of a severe asthma attack?

A
  • Inability to complete sentences
  • Pulse >110bpm
  • Respiratory rate >25/min
  • PEF 33-50% predicted
33
Q

What are the signs of a life threatening asthma attack?

A
  • Silent chest
  • Confusion
  • Exhaustion
  • Cyanosis
  • Bradycardia
  • PEF <33% predicted
34
Q

What does spirometry testing involve?

A

Breathing out as fast as you can through a mouthpiece attached to a spirometer

35
Q

What does a spirometer measure?

A

The amount of air you breathe out in one second (FEV1) and the total amount of air you can hold in your lungs (FVC)

36
Q

What are spirometry readings compared against?

A

Normal measurements for the patients age, gender, and height

37
Q

How is spirometry used in the diagnosis of asthma?

A

Spirometry is performed, and then repeated a few minutes after taking a bronchodilator to see if results improve. If they do, this is a strong indicator of asthma.

38
Q

What does peak flow testing measure?

A

How fast you can blow air out of your lungs in one breath

39
Q

How is peak flow testing performed?

A

The patient breathes out as quickly and as hard as possible into a peak flow meter

40
Q

What are the results of peak flow testing compared against?

A

The normal for someone of the same age, height, and gender

41
Q

What is the advantage of patients being able to take peak flow meters home?

A

They can record their peak flow over a period of weeks, which can be especially helpful when asthma is suspected, but peak flow and spirometry are normal when measured

42
Q

What is the purpose of airway responsiveness testing?

A

To test how the airways respond to an asthmatic trigger

43
Q

What happens in airway responsiveness testing?

A

The patient will be asked to breath in a medication that will irritate the airways slightly in an asthmatic patient. They will then have a spirometry test to see if breathing has been affected.

44
Q

What can be used as an alternative to medication in airway responsiveness testing?

A

Exercise

45
Q

What is the aim of airway inflammation testing?

A

To determine if there is any inflammation present in the airways.

46
Q

How is airway inflammation testing done?

A

Either by taking a mucus sample and assessing it for any signs of inflammation, or looking at the concentration of nitric oxide in an expiratory breath

47
Q

What is the relevance of measuring nitric oxide in an expiratory breath?

A

Nitric oxide can be a sign of inflammation

48
Q

When is allergy testing performed?

A

When there is suspicion that asthma is triggered by an allergy, but it is unknown what to do

49
Q

What methods are commonly used in allergy testing?

A
  • Skin prick test
  • Blood test
50
Q

How is a skin prick test performed?

A
51
Q

How is a skin prick test interpreted?

A

If the patient develops a small blister within 15 minutes, it indicates they are allergic to that allergen are present

52
Q

How can blood tests be used in allergy testing?

A

To see if substance that are produced by the body in response to an allergen is present

53
Q

What are the steps in the management of an acute severe asthma attack?

A
  1. Assess the severity of the attack
  2. Supplemental oxgyen to maintain sats 94-98%
  3. Salbutamol 5mg (or terbuatline 10mg) nebulised with oxygen. If severe/life-threatening, add ipratropium 0.5mg/6hours to nebulisers
  4. Hydrocortisone 100mg IV, or prednisolone 40-50mg PO
  5. Reassess every 15 minutes
54
Q

What is an assessment of the severity of an asthma attack based on?

A
  • PEF
  • Ability to speak
  • Pulse rate
  • Oxygen saturations
55
Q

What should be done if PEF <75% after initial treatment for an acute severe asthma attack?

A

Should repeat salbutamol nebulisers every 15-30 minutes, or 10mg/hour continuously. Add ipratropium if not already given

56
Q

Why does the ECG need to be monitored in a patient with acute severe asthma?

A

To watch for arrhythmia

57
Q

What drug be considered for administration in a single dose in those with severe/life-threatening features that do not have a good initial response to therapy?

A

Magnesium sulphate 1.2-2g IV over 20 minutes

58
Q

What should be done if a person is not improving after initial management for acute severe asthma?

A

Refer to ICU for consideration of ventilator support and intensification of medical therapy, e.g. aminophylline, IV salbutamol

59
Q

What are the indications for ICU treatment in an asthma attack?

A
  • Deteriorating PEF
  • Persistent/worsening hypoxia
  • Hypercapnia
  • ABG showing low pH or high H+
  • Exhaustion or feeble respiration
  • Drowsiness, confusion, altered conscious level
  • Respiratory arrest
60
Q

What should be done if after treatment for acute severe asthma the person is improving within 15-30 minutes?

A
  • Continue nebulized salbutamol every 4-6 hours
  • Prednisolone 40-50mg PO OD for 5-7 days
  • Monitor peak flow and oxygen saturations, aim for 94-98% with supplemental oxygen if need
  • If PEF >75% 1hour after initial treatment, consider discharge with outpatient follow-up
61
Q

What are the management options for chronic asthma?

A
  • Lifestyle changes
  • Patient education
  • Short-acting reliever inhalers
  • Preventer inhalers
  • Combined preventer and long-acting reliever inhalers

ANKI Respiratory (17 decks)

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