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Resp > 4) Asthma > Flashcards

4) Asthma Flashcards

1
Q

Definition of Asthma?

A

Paroxysmal and reversible obstruction of the airways. An inflammatory disease characterised by bronchospasm and excessive production of secretions

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2
Q

3 Factors causing symptoms in asthma?

A
  • Bronchial muscle contraction
  • Mucosal swelling/inflammation (mast cell/basophil degranulation)
  • Increased mucus production
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3
Q

Symptoms of asthma?

A

Intermittent dyspnoea
wheeze
cough (often nocturnal)
Sputum

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4
Q

Key things to get from the Hx?

A 
Precipitants? 
Diurnal variation?
Exercise tolerance?
Sleep disturbance? (nights/week?)
acid reflux?
atopy?
job?
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5
Q

Signs of Asthma?

A

Tacypnoea, audible wheeze, hyperinflation, hyperresonant, air entry decr. widespread polyphonic wheeze

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6
Q

Signs of a severe asthma attack?

A

Cant complete sentence, high pulse, RR>25, PEF 33-50%

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7
Q

Signs of life threatening attack?

A

Silent chest, confusion, exhaustion, cyanosis, bradycardia, PEF<33%
IF CO2 STARTS TO RISE THEY GON DIE

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8
Q

Risk factors for developing asthma?

A 
FHx of atopy
Low BW
not breastfeeding
Maternal smoking
Air pollution
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9
Q

What is samters triad?

A

Asthma, polyps, aspirin sensitivity

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10
Q

Testing for chronic asthma?

A

PEF monitoring
20% variation on 3 days/week for 2 weeks

Spirometry shows obstructive defect
Usually an increase of 15% with b agonists

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11
Q

DD of asthma?

A 
Pulmonary oedema ('cardiac asthma')
COPD
Airway obstruction
SVC obstruction
Pneumothorax
PE
Bronchiectasis
Obliterative bronchiolitis (suspect in elderly)
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12
Q

Diagnosis of asthma?

A

Is on clinical judgement of symptoms and objective tests, but a normal spirometry does not rule out asthma. Bronchodilator revesibility is highly sugestive, PEF, FHx

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13
Q

Management of Chronic Asthma?

A

Conservative: Stop smoking, avoid precipitants, check inhaler technique, written asthma plan

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14
Q

What is the first stage of asthma medication?

A

SABA and low dose ICS

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15
Q

When should you move up the asthma ladder?

A

If using SABA more than 3x a week

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16
Q

Step 2 on asthma ladder?

A

Add LABA, usually as combi with ICS

17
Q

Step 3 on asthma ladder?

A

Depends on response to LABA

If some response, keep going and incr. ICS
OR add LTRA, LAMA, theophylline

If no response stop LABA and increase ICS

18
Q

Step 4 on asthma ladder?

A

Trial:
High dose ICS
4th drug: (LTRA, theophylline, B agonist PO, LAMA)
REFER

19
Q

Step 5?

A

Oral Pred

REFER

20
Q

Why should you prescribe beclemetasone by name?

A

QVAR is twice as potent

21
Q

How do B agonists work? S/E?

A

Relax bronchial smooth muscle by incr. cAMP

s/e: tremor, anxiety, decr. k+

22
Q

how do LABA work?

A

Help nocturnal symptoms and reduce morning dips. Can cause paroxysmal bronchospasm

23
Q

Corticosteroids? S/E?

A

Act over days to reduce mucosal inflammation. Rinse mouth after to prevent candidiasis, s/e as all steroids

24
Q

Aminophylline?

A

Becomes theophyliine in the body, inhibits phosphodiesterase and therefore incr. cAMP and decr. Bronchospasm. Narrow therapeutic window

25
Q

LTRA?

A

eg monteleukast– block leukotreines by antagonising cystLT1 receptor

26
Q

Omalizumab?

A

Anti IgE MAb Highly selective pts with persistant allergic asthma. Specialist only

27
Q

Acute asthma spirometry changes?

A

FEV1, FEV1/FVC down
FVC down
RV up
Increased FRC and TLC

28
Q

What to get in the HX in acute attack?

A

previous admissions
ITU admissions?
Best PEFR?

29
Q

How do you grade severity?

A

Moderate: PEFR 50-75% best

Severe: 33-50%
RR 25+
Hr 120+
Cant finish sentences

Life threatening:<33%
altered consciousness
exhaustion
arrhythmia
hypotension
cyanosis
silent chest
poor effort
hypoxaemia

IF CO2 rises then peri arrest
intubate with raised inflation pressure

30
Q

Treatment for exacerbation of asthma?

A

Oxygen

Bronchodilatiors: -Drive with o2 at 6l/min
Salbutamol 2.5-5mg and repeat at 15-30
Ipratropium bromide 500 ug QDS

Steroids: Pred 40-50mg
at least 5 days or til recovery

Magnesium: bronchodilatior, 2g IV over 20 min if life threatening

31
Q

When should you refer asthma to ITU?

A 
Deteriorating PEF
Hypoxia worsening
hypercapnia
exhaustion
arrest
altered mental state
32
Q

How should management change in pregnancy?

A

It doesnt, give the drugs

33
Q

Asthma review questions

A

Have you had any difficulty sleeping because of your asthma?
Have you had you had your usual asthma symptoms during the day?
Has your asthma interfered with your usual activities? Check inhaler technique and compliance and use of inhalers

Resp (11 decks)

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