6 - Asthma and COPD Flashcards
What is the pathophysiology of asthma?
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- Chronic reversible airway obstruction that responds to bronchodilators
- Increased airway responsiveness and narrowing to stimuli
- Airway narrowing: bronchial muscle contraction, mucosal swelling due to mast cells and basophils releasing mediators, increased mucus production
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What are the signs and symptoms of asthma?
Symptoms: Intermittent dyspnea, wheeze, nocturnal cough, sputum
Signs: tachypnea, audible wheeze, hyperinflated chest
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What are some differentials for a wheeze apart from asthma>
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If a patient presents with asthmatic like symptoms, what are some questions you need to ask in the history?
- Triggers: e.g cold air, exercise, pets, smoking, NSAIDs
- Diurnal variation: worse at night?
- Exercise tolerance
- Disturbed sleep?
- Other atopic diseases?
- Job?
- Days per week off school or work?
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When is asthma classified as mild, moderate, severe, life threatening and near fatal?
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What does PEF depend on?
- Age
- Gender
- Height
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What is the emergency management for acute asthma?
- Aim for sats of 94-98% with oxygen. If <92% ABG needed
- 5mg Salbutamol NEB and repeat after 15 minutes
- 40mg oral prednisolone or IV hydrocortisone
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How do you initially diagnose asthma?
What investigations should you do if a patient is having an acute episode of asthma?
- PEF
- Sputum culture and ?Blood culture
- FBV, U+Es, CRP
- ABG
- CXR to exclude infection or pneumonthorax
What investigations can you do for a patient with chronic asthma?
- PEF monitoring (diurnal variation with >20% variability on >3days in 2 weeks)
- CXR may have hyperinflation
- Spirometry (obstructive pattern, ratio<70% with bronchodilator reversibility)
- Skin prick test to identify allergens
- Metacholine or Histamine challenge
What is the criteria that needs to be fulfilled for a safe discharge after an asthma exacerbation?
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What factor means a patient with asthma will be responsive to steroids?
Eosinophillia
Apart from asthma, what are some diseases that cause eosinophilia?
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What are some common asthma triggers?
- Smoking
- URTI
- Pollen
- Pets
- Exercise
- Cold air
- Aspirin and beta blockers
- Stress
- Occupational exposures
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What is the general management of asthma in a primary care setting?
- Avoid triggers
- Stop smoking
- PEF monitoring
- Self management plan for emergencies
- BTS pharmacological management
- Treat correct inhaler technique
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What is the pharmocological management of asthma using the BTS guidelines?
Start at step most appropriate to severity, moving up or down. Can move down after >3months of control
1st: SABA reliever when needed
2nd: Add low dose ICS
3rd: Add LABA with the ICS or LTRA or oral theophylline
4th: Increase ICS
5th: Add regular oral prednisolone with specialist input
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What signifies poor asthma control?
- 3 or more days a week with symptoms
- 2 or more days a week with use of a rescue SABA inhaler
- 1 or more nights a week with awakening due to asthma
Need to check inhaler technique, inhaler adherance, smoking and self management plan
How do beta-agnonists help asthmatics and what are the side effects of these?
Relax bronchial smooth muscle within minutes by increasing cAMP
SE: tachyarrhythmias, hypokalaemia, tremor, paradoxical bronchospasm
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How do inhaled corticosteroids help asthma and what are the side effects of these?
Act over days to decrease bronchial mucosal inflammation
Used inhaled to minimise systemic effects
SE: usual steroid side effects, oral thrush so rinse mouth adter use
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How does aminophylline help asthmatics and what are some side effects of this?
Metabolised to theophylline. Inhibits phosphodiesterase so decreases bronchoconstriction.
Used as prophylaxis at night
SE: arrhythmias, GI upsets, seizures
Monitoring: theophylline levels, ECG monitoring
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How do LTRA help asthmatics?
Block the effects of leukotrienes by antagonising the CystLT1 receptor
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