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Respiratory System (CA) > 9a. Clinical features of Asthma in Adults > Flashcards

9a. Clinical features of Asthma in Adults Flashcards

1
Q

Define Asthma

A

A disease characterised by an INCREASED RESPONSIVENESS of trachea and bronchi to various stimuli and manifested by a WIDESPREAD NARROWING of airways that CHANGES IN SEVERITY either spontaneously or as a result of therapy

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2
Q

What is the prevalence of Asthma in children?

A

10-15% M>F

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3
Q

What is the prevalence of Asthma in adults?

A

5-10% F>M

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4
Q

How many people are receiving asthma treatment?

A

5.4 million (1.1 million children, 4.3 million adults)

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5
Q

How many deaths per annum?

A

~1000

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6
Q

In which activity is asthma, most limiting?

A

Running 25-30%

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7
Q

What is it also limiting in?

A 
Sport
Stairs
Pets
DIY
Gardening
Pub
Walking 
Sleeping
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8
Q

In the UK what is the statistics for admissions, bed days and GP consultations?

A

67,000 admissions, 220,000 bed days, 4.1 million GP consultations

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9
Q

How much does it cost the NHS annually?

A

£2,349m

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10
Q

What is the trend in asthma cases over the past few decades?

A

Rapid increase in the amount of cases

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11
Q

What are the proven risk factors for asthma?

A

Genetic
Occupation
Smoking

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12
Q

What is the Genetic risk factor?

A

Atopy

  • Inherited tendency to IgE response to allergens
  • Asthma, eczema, hayfever, food allergy
  • Markers, skin prick tests, IgE
  • Strongest risk factor: personal, familial atopic tendency
  • Maternal atopy most influential (3x father)
  • Linkage studies, two groups of genetic associations:
    1) immune response genes; IL-4, IL-5, IgE
    2) airway genes; ADAM33
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13
Q

What is the Occupational risk factor?

A
  • Underestimated (10-15% of adult onset asthma)
  • Interactions with smoking & atopy
Isocyanates = twin pack paints
Colophony = welding solder flux
Laboratory animals = rodent urinary proteins
Grains = wheat proteins, grain mites
Enzymes = subtilisin, amylase
Drugs = antibiotics, salbutamol
Crustaceans = prawns, crabs
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14
Q

What is the Smoking risk factor?

A 
Maternal smoking during pregnancy
v FEV1 
^ Wheezy illness
^ Airway responsiveness
^ asthma , ^ severity

‘Grandmother effect’

Mother smoked - 1.5 (1.0-2.3)
Maternal grandmother smoked - 2.1 (1.4-3.2)
Mother & Maternal grandmother smoked - 2.6 (1.6-4.5)

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15
Q

What is are possible risk factors for Asthma?

A

Obesity
Diet
Reduced exposure to microbes/microbial products
Indoor pollution: chemical household products

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16
Q

What is the Obesity risk factor?

A

Body mass index positively associated with

  • asthma
  • wheezing
  • airway hyperractivity
17
Q

What is the Reduced exposure to microbes/microbial products risk factor?

A

Children born on farms less likely to develop asthma
Greaterexposure to microbes/microbial products on farm
- endotoxin
- glucans
- extracapsular polysaccharide
Microbial diversity appears to be important in reducing the risk of asthma and allergy

18
Q

What is the Indoor pollution risk factor?

A

Volatile organic compounds, formaldehyde, fragrances

Cleaners at increased risk of asthma OR 1.97 (1.33 – 2.92)

Adults who use sprays
weekly 1.49 (1.12-1.99) times more likely to be asthmatic
4 days/wk 2.11 (1.15-3.89) times more likely to be asthmatic

Mothers using sprays during pregnancy, children asthma

19
Q

What are environmental allergens?

A

House dust mite
Cat
Grass Pollen (Timothy grass)

Exposure does not initiate/cause atopy/asthma, factors associated with affluence increase the likelihood of sensitisation to local allergens

20
Q

What are the clinical aspects of Asthma?

A

Trying to differentiate from other causes of wheeze

  • Localised airway obstruction, inspiratory stridor, tumour, foreign body
  • Generalised airflow obstruction
    • asthma (reversible AFO)
    • COPD (irreversible AFO)
    • bronchiectasis
    • bronchiolitis
    • Cystic Fibrosis
21
Q

What are the Symptoms commonly associated with asthma but not solely associated?

A 
Wheeze
Shortness of breath (dyspnoea)
Chest Pain
Paroxysmal dry cough
Sputum (occasional)
22
Q

What is most important for making an asthma diagnosis?

A

History

23
Q

What are the triggers?

A 
Exercise
Cold air
Smoke
perfume
URTI's 
Pets
Tree
Grass pollen
Food
Aspirin
24
Q

What are evidence of variable symptoms?

A 
Triggers
Daily variation (nocturnal/early morning)
Weekly variation (occupation, better at weekends & holidays)
Annual variation (environmental allergens)
25
Q

What is usual unhelpful in clinical examination?

A

Breathless on exertion
Hyperepanded chest
Polyphonic wheezes

26
Q

Which symptoms indicate its probably not asthma?

A

Clubbing, cervical lymphadenopathy
Stridor
Asymmetrical expansion
Dull percussion note (lobar collapse, effusion)
Crepitations (bronchiectasis, CF, alveoli’s, LVF)

27
Q

What are you essential investigations?

A

Airflow obstruction variability
Variability and/or reversibility of airflow obstruction

If obstructed picture:

  • Full pulmonary function testing
  • Reversibility to bronchodilator
  • Reversibility to oral corticosteroids

If normal spirometry:
- Variability of airflow obstruction

28
Q

How is occupational asthma diagnosed?

A
  • Suspicion from work related symptoms
  • Working with recognised occupational sensitiser

Confirmation
- Serial peak flow readings
_2 hourly best: 5/d minimum
_2 pairs of exposed/unexposed periods (at least
- Antibodies
- Bronchial challenge (useful if doubt, new agent)

Positive response to Colophony
No response to methyl ester, maleic ester

29
Q

What are specialist investigations?

A
  • Airway responsiveness to methacholine/histamine

- Exhaled nitric oxide (NO) (NICE Guideline likely to increase use of this)

30
Q

What are useful investigations?

A

Chest x-ray
Skin prick testing (atopic status)
Total and specific IgE (atopic status)
Full blood count

31
Q

What is used in assessment of acute and severe asthmas?

A 
Objective >subjective
- Ability to speak
- Heart rate
- Respiratory rate
- PEF
- Oxygen saturation / Arterial blood gases
No need for pulses paradoxus
32
Q

What are the statistics for Moderate asthma?

A 
Essentially increasing symptoms, no features of severe
Able to speak, complete sentences
HR <110
RR <25
PEF 50 - 75% predicted or best
SaO2 > 92% (no need for ABG)
PaO2 > 8kPa
33
Q

What are the statistics for Severe asthma?

A 
Any one of 
Unable to speak, unable to complete sentences 
HR >110
RR >25
PEF  33 - 50% predicted or best
SaO2 > 92% 
PaO2 > 8kPa
34
Q

What are the statistics for Life Threatening asthma?

A 
Any one of
Grunting
Impaired consciousness, confusion, exhaustion
HR >130, or bradycardic
Hypoventilating
PEF < 33% predicted or best
Cyanosis

SaO2 < 92%
PaO2 < 8kPa
PaCO2 normal (4.6 - 6.0kPa)

Near Fatal
Raised PaCO2

35
Q

What are the statistics for Life Threatening asthma?

A 
Any one of
Grunting
Impaired consciousness, confusion, exhaustion
HR >130, or bradycardic
Hypoventilating
PEF < 33% predicted or best
Cyanosis

SaO2 < 92%
PaO2 < 8kPa
PaCO2 normal (4.6 - 6.0kPa)

Near Fatal
Raised PaCO2

Respiratory System (CA) (32 decks)

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