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Yr3 Respiratory > 6. Asthma > Flashcards

6. Asthma Flashcards

1
Q

What are the main 3+1 symptoms for Asthma?

A

Combination of:

  1. Cough
  2. Wheeze
  3. Breathlessness
  4. Chest Tightness

With Variable Airflow Obstruction

(Also Airway Hyperresponsiveness/Inflammation)

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2
Q

Roughly how many people in the UK receive treatment for Asthma?

A

5.4 Million

1 in 11 Children, 1 in 12 Adults

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3
Q

List 5 different phenotypes of Asthma

A
  1. Allergic Asthma
  2. Non-Allergic Asthma
  3. Adult-onset (LATE) Asthma
  4. Asthma w Persistent Airflow Limitation
  5. Asthma with Obesity
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4
Q

How does the Sympathetic NS affect the airways?

A

Activating B2 Receptors

Bronchodilation + Mucociliary Clearance

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5
Q

How does the Parasympathetic NS affect the airways?

A

Activating Muscarinic Receptors

Bronchoconstriction

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6
Q

What is the equation describing Flow?

A

Pressure Change/Resistance

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7
Q

How is Airflow increased? What rule do we use?

A

Airflow can be increased by increasing the Pressure Change OR decreasing Airway resistance

Pouseille’s Law (1/r^4)

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8
Q

What cells are responsible for causing the Acute Phase of Asthma?

A

Mast Cells

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9
Q

During the Acute phase of Asthma, what happens?

A

Mucosal and Bronchial Wall inflammation

Induces a Bronchospasm due to:

  • Mucosal Oedema
  • Mucus Plugging
  • Smooth Muscle Spasm
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10
Q

What cells are responsible for causing the Late Phase of Asthma?

A

Th2 Helper Cells ->
B cells ->
IgE and Eosinophils

Leads to constriction and Muco-secretion

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11
Q

What can cause Extrinsic Asthma?

A
  1. Air pollution
  2. Allergen Exposure
  3. Genetics
  4. Hygiene Hypothesis
  5. Maternal Smoking
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12
Q

What can cause Intrinsic Asthma?

A
  1. Colds and Infections

2. Non-allergies

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13
Q

What features make Asthma diagnosis MORE likely?

A
  1. One of the following in episodes:
    - Wheeze
    - Breathlessness
    - Chest Tightness
    - Cough
  2. Variability: Worse at night AND morning
  3. Triggered by
    - Allergen
    - Beta Blocker
    - Cold Air
    - Drugs (Aspirin)
    - Exercise
  4. Family history of Atopy/Asthma
  5. Low PEFR/FEV
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14
Q

What is the first step during diagnosing Asthma?

A

Test for Airway Obstruction

  • Spirometry
  • Bronchodilator Reversibility
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15
Q

How do we test for Variability?

A
  1. PEF Charting

2. Challenge Testing

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16
Q

How do we test for Eosinophilic Inflammation or ATOPY?

A
  1. FeNO
  2. Blood eosinophil test
  3. Skin-Prick Test
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17
Q

List Five Differential Diagnoses for Wheezing

A
  1. Asthma
  2. COPD
  3. Obstruction
  4. Pulmonary Oedema
  5. Anaphylaxis
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18
Q

What can we generally see in people with Asthma compared with COPD?

A
  1. Daily FEV1 variation

2. Reversibility

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19
Q

What can we generally see in people with COPD compared with Asthma?

A
  1. Older
  2. Smoker
  3. Sputum
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20
Q

Upon using a Bronchodilator, what is the diagnostic result after use for Asthmatics?

A

> 12% or 200 mL improvement in their FEV1

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21
Q

Upon performing a FENO test, what are we testing for and what is the result?

A

Marker for Eosinophilic Inflammation

> 40 parts per billion

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22
Q

What is Eosinophilic Asthma?

A

Phenotype of Asthma associated with Rise in NO in exhaled breath

Eosinophils use iNOS to make NO

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23
Q

What do we use for Direct Challenge Testing in Asthmatics?

A

Methacholine

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24
Q

What is the diagnostic result of Direct Challenge Testing?

A

Seeing the concentration needed to cause 20% fall in FEV1 of 8mg/ml or less
(PC20 - Provocation Concentration)

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25
Q

What is the Accuracy rate of FENO?

A

1 in 5 False Positive/Negative Rate

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26
Q

What is the Accuracy rate of DCT?

A

2/3rds with Positive will have asthma

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27
Q

How often do we use Peak Flow Variability testing?

A

Twice Daily over Two Weeks

Testing Diurnal Variation

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28
Q

What is the variability seen in Asthmatics during Peak Flow?

A

20%

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29
Q

Name all tests you could do during diagnosis of Asthma

A
  1. Spirometry
  2. Bronchodilator Reversibility
  3. FENO
  4. DCT
  5. Peak Flow Variability
  6. Skin Prick Test
  7. IgE
  8. FBC/Eosinophil Count
30
Q

What are the two main ways of arranging a Management Plan?

A
  1. Specialist Nurse Review

2. Self-Management Plan

31
Q

What is the MoA of SABA/LABA?

A

Sympathetic -> B2R -> Bronchodilation and Mucociliary Clearance

  • Relax SM
  • Relieve Bronchospasm
32
Q

Give 2 examples of SABA

A

Salbutamol

Terbutaline

33
Q

Give 2 examples of LABA

A

Salmeterol

Formoterol

34
Q

What are the main side effects of SABA/LABA

A
  1. Tremor
  2. Agitation
  3. Tachycardia
  4. Sweating
35
Q

What is the MoA of Corticosteroids?

A

Decrease Inflammation

36
Q

Give 3 examples of Corticosteroids

A

Budesonide
Beclometasone
Fluticasone

37
Q

What are the main side effects of Corticosteroids?

A
  1. Oral Candidiasis

2. Systemic Side effects

38
Q

What is the MoA of Leukotriene Antagonists?

A

Block LTR Receptors in SM

Reduces Bronchoconstriction

39
Q

Give an example of Leukotriene Antagonists

A

Montelukast

40
Q

What are the main Side Effects of LTRA

A
  1. Nausea

2. Headache

41
Q

What is the MoA of Anti-IgE?

A
  1. Monoclonal Antibody to IgE and Decreases IgE
42
Q

Give an example of Anti-IgE and how to administer it?

A

Omalizumab (Subcutaneous)

43
Q

What are the main side effects of Anti-IgE?

A
  1. Joint Pain
  2. Anaphylaxis
  3. Itching
  4. Nausea
  5. Headache
44
Q

When would you take Anti-IgE?

A

When the patient is confirmed Allergic/IgE-mediated asthma and as an add-on to optimised standard therapy

Continuous/Frequent treatment with Oral CS

45
Q

What is the definition of uncontrolled Asthma?

A

3+ Days a week with symptoms

3+ Days a week with required SABA relief

1+ Night with awakening due to asthma

46
Q

How can we assess Future risks of Asthma Attacks?

A
  1. Ask about History of previous attacks
  2. Assess current asthma control
  3. Review Reliever use
  4. Children: Regard obesity and exposure
  5. Adults: Regard age, gender, lung function etc
47
Q

What are the 5 different types of Asthma in regards to severity?

A
  1. Near-fatal
  2. Life-threatening
  3. Acute Severe
  4. Moderate
  5. Brittle
48
Q

What is considered Type 1 Brittle Asthma?

A
  1. Wide PEF Variability (>40% diurnal variation) despite intense therapy
49
Q

What is considered Type 2 Brittle Asthma?

A
  1. Sudden severe attacks despite apparently well-controlled asthma
50
Q

What is considered Moderate Asthma exacerbation?

A
  1. Increasing symptoms
  2. No features of Acute-Severe
  3. PEF of 50-75% best or predicted
51
Q

What is considered Acute Severe Asthma Exacerbation?

A

Any one of:

  1. PEF 33-50% best/predicted
  2. RR 25
  3. HR 110
  4. Cannot complete sentences in a breath
52
Q

What is considered Life-threatening Asthma?

A

33-92-CHEST

  1. PEF< 33%
  2. Sats<92%
  3. Cyanosis
  4. HypOtension
  5. Exhaustion
  6. Silent Chest
  7. Tachycardia or Bradycardia
53
Q

What is considered Near Fatal Asthma?

A
  1. Raised PaCO2

2. Needs Mechanical Ventilation with Raised inflation pressures

54
Q

Regarding Asthma patients who to admit and to discharge, who should we Admit?

A
  1. Life Threatening Attacks

2. Severe attacks persisting after initial treatment

55
Q

Regarding Asthma patients who to admit and to discharge, who should we Discharge?

A

PEF > 75% after 1 hour UNLESS:

  1. Significant symptoms
  2. Pregnant
  3. Alone
  4. Learning difficulties
  5. Previous Near-Fatal/Brittle Asthma
56
Q

What drugs are best given to those who need immediate management of Asthma?

A
  1. Oxygen
  2. Salbutamol
  3. Hydrocortisone/Prednisolone
  4. Ipratropium Bromide
  5. Theophylline
  6. Magnesium Sulphate
57
Q

How is Salbutamol given in an emergency situation?

A
  1. Nebulised with Oxygen

2. 2.5-5mg given every 10 minutes

58
Q

What are the main side effects of Salbutamol?

A
  1. Tremor
  2. Arrhythmias
  3. Hypokalemia (Monitor ECG)
59
Q

How is Hydrocortisone given in an emergency situation?

A
  1. IV 100-200 mg QDS
60
Q

How is Prednisolone given in an emergency situation?

A
  1. PO 40mg OD
61
Q

How is Ipratropium Bromide given in an emergency situation?

A
  1. Nebulised with Oxygen

2. 500 ug every 4-6 hours

62
Q

What is the function of Ipratropium Bromide?

A

Acts as a Muscarinic antagonist for bronchodilation

63
Q

What are the main side effects of Ipratropium Bromide?

A
  1. Cough
  2. Headache
  3. Arrhythmias
  4. Dry Mouth
  5. Dizziness
  6. Nausea
64
Q

When is Magnesium Sulphate usually given?

A

In Acute Severe Asthma

65
Q

How is Ipratropium Bromide given in an emergency situation?

A
  1. IV 1.2-2g over 20 minutes
66
Q

When should Theophylline be given for asthmatics?

A

Life-threatening situations

May require senior guidance

67
Q

What are the side effects of Theophylline?

A
  1. Palpitations
  2. Arrhythmias
  3. Seizures
  4. Alkali burns (Extravasation)
  5. Nausea
  6. Drug interactions
68
Q

When should the ITU be involved for asthmatics?

A
  1. Any patients needing ventilatory support
  2. Near fatal asthma
  3. Life-threatening/Acute-Severe
69
Q

What should be monitored for Asthmatic Patients?

A
  1. Regular Peak Flow
  2. Oxygen Sats + Chest Ausc
  3. ABG
  4. Bloods (K, Glucose)
  5. ECG (Potassium/Magnesium/Beta2)
70
Q

When monitoring asthmatic patients, when would you repeat ABG and how often?

A

Repeat ABG every hour if:

  1. Hypoxic
  2. Normo-hypercapnoeic
  3. Patient deterioration
71
Q

When can discharges be planned for Asthma patients?

A
  1. Improved Symptoms
    - Clinical signs compatible with home management
    - Therapy can be continued at home
  2. Improved Peak Flow
    - 75+% best/predicted
    - <25% diurnal varation
  3. Follow-up
    - After 48 hours
    - <30 days post discharge by GP/Nurse specialist

Yr3 Respiratory (5 decks)

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