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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
What is the Accuracy rate of FENO?
1 in 5 False Positive/Negative Rate
26
What is the Accuracy rate of DCT?
2/3rds with Positive will have asthma
27
How often do we use Peak Flow Variability testing?
Twice Daily over Two Weeks | Testing Diurnal Variation
28
What is the variability seen in Asthmatics during Peak Flow?
20%
29
Name all tests you could do during diagnosis of Asthma
1. Spirometry 2. Bronchodilator Reversibility 3. FENO 4. DCT 5. Peak Flow Variability 6. Skin Prick Test 7. IgE 8. FBC/Eosinophil Count
30
What are the two main ways of arranging a Management Plan?
1. Specialist Nurse Review | 2. Self-Management Plan
31
What is the MoA of SABA/LABA?
Sympathetic -> B2R -> Bronchodilation and Mucociliary Clearance - Relax SM - Relieve Bronchospasm
32
Give 2 examples of SABA
Salbutamol | Terbutaline
33
Give 2 examples of LABA
Salmeterol | Formoterol
34
What are the main side effects of SABA/LABA
1. Tremor 2. Agitation 3. Tachycardia 4. Sweating
35
What is the MoA of Corticosteroids?
Decrease Inflammation
36
Give 3 examples of Corticosteroids
Budesonide Beclometasone Fluticasone
37
What are the main side effects of Corticosteroids?
1. Oral Candidiasis | 2. Systemic Side effects
38
What is the MoA of Leukotriene Antagonists?
Block LTR Receptors in SM | Reduces Bronchoconstriction
39
Give an example of Leukotriene Antagonists
Montelukast
40
What are the main Side Effects of LTRA
1. Nausea | 2. Headache
41
What is the MoA of Anti-IgE?
1. Monoclonal Antibody to IgE and Decreases IgE
42
Give an example of Anti-IgE and how to administer it?
Omalizumab (Subcutaneous)
43
What are the main side effects of Anti-IgE?
1. Joint Pain 2. Anaphylaxis 3. Itching 4. Nausea 5. Headache
44
When would you take Anti-IgE?
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
What is the definition of uncontrolled Asthma?
3+ Days a week with symptoms 3+ Days a week with required SABA relief 1+ Night with awakening due to asthma
46
How can we assess Future risks of Asthma Attacks?
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
What are the 5 different types of Asthma in regards to severity?
1. Near-fatal 2. Life-threatening 3. Acute Severe 4. Moderate 5. Brittle
48
What is considered Type 1 Brittle Asthma?
1. Wide PEF Variability (>40% diurnal variation) despite intense therapy
49
What is considered Type 2 Brittle Asthma?
1. Sudden severe attacks despite apparently well-controlled asthma
50
What is considered Moderate Asthma exacerbation?
1. Increasing symptoms 2. No features of Acute-Severe 3. PEF of 50-75% best or predicted
51
What is considered Acute Severe Asthma Exacerbation?
Any one of: 1. PEF 33-50% best/predicted 2. RR 25 3. HR 110 4. Cannot complete sentences in a breath
52
What is considered Life-threatening Asthma?
33-92-CHEST 1. PEF< 33% 2. Sats<92% 3. Cyanosis 4. HypOtension 5. Exhaustion 6. Silent Chest 7. Tachycardia or Bradycardia
53
What is considered Near Fatal Asthma?
1. Raised PaCO2 | 2. Needs Mechanical Ventilation with Raised inflation pressures
54
Regarding Asthma patients who to admit and to discharge, who should we Admit?
1. Life Threatening Attacks | 2. Severe attacks persisting after initial treatment
55
Regarding Asthma patients who to admit and to discharge, who should we Discharge?
PEF > 75% after 1 hour UNLESS: 1. Significant symptoms 2. Pregnant 3. Alone 4. Learning difficulties 5. Previous Near-Fatal/Brittle Asthma
56
What drugs are best given to those who need immediate management of Asthma?
1. Oxygen 2. Salbutamol 3. Hydrocortisone/Prednisolone 4. Ipratropium Bromide 5. Theophylline 6. Magnesium Sulphate
57
How is Salbutamol given in an emergency situation?
1. Nebulised with Oxygen | 2. 2.5-5mg given every 10 minutes
58
What are the main side effects of Salbutamol?
1. Tremor 2. Arrhythmias 3. Hypokalemia (Monitor ECG)
59
How is Hydrocortisone given in an emergency situation?
1. IV 100-200 mg QDS
60
How is Prednisolone given in an emergency situation?
1. PO 40mg OD
61
How is Ipratropium Bromide given in an emergency situation?
1. Nebulised with Oxygen | 2. 500 ug every 4-6 hours
62
What is the function of Ipratropium Bromide?
Acts as a Muscarinic antagonist for bronchodilation
63
What are the main side effects of Ipratropium Bromide?
1. Cough 2. Headache 3. Arrhythmias 4. Dry Mouth 5. Dizziness 6. Nausea
64
When is Magnesium Sulphate usually given?
In Acute Severe Asthma
65
How is Ipratropium Bromide given in an emergency situation?
1. IV 1.2-2g over 20 minutes
66
When should Theophylline be given for asthmatics?
Life-threatening situations May require senior guidance
67
What are the side effects of Theophylline?
1. Palpitations 2. Arrhythmias 3. Seizures 4. Alkali burns (Extravasation) 5. Nausea 6. Drug interactions
68
When should the ITU be involved for asthmatics?
1. Any patients needing ventilatory support 2. Near fatal asthma 3. Life-threatening/Acute-Severe
69
What should be monitored for Asthmatic Patients?
1. Regular Peak Flow 2. Oxygen Sats + Chest Ausc 3. ABG 4. Bloods (K, Glucose) 5. ECG (Potassium/Magnesium/Beta2)
70
When monitoring asthmatic patients, when would you repeat ABG and how often?
Repeat ABG every hour if: 1. Hypoxic 2. Normo-hypercapnoeic 3. Patient deterioration
71
When can discharges be planned for Asthma patients?
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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