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Year 3 Respiratory Core Conditions > Acute Asthma > Flashcards

Acute Asthma Flashcards

1
Q

What % of the population does asthma affect?

A

5-8%

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2
Q

What is asthma characterised by?

A 
recurrent episodes of :
-dyspnoea
-cough
-wheeze
caused by reversible airways obstruction.
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3
Q

What 3 factors contribut to airway narrowing ?

A

1) bronchial muscle contraction
2) mucosal swelling / inflammation
3) increased mucus production

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4
Q

What are the symptoms of asthma?

A
  • intermittent dyspnoea
  • wheeze
  • cough (often nocturnal)
  • sputum
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5
Q

What are the precipitants of asthma?

A
  • cold air
  • exercise
  • emotion
  • allergens e.g. house dust mite, pollen, fur
  • infection
  • smoking
  • pollution
  • NSAIDs
  • beta blockers
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6
Q

What is diurnal variation? (peak flow)

A

Patients who suffer from asthma may have variation in their symptoms or peak flow depending on the time of day.
-Marked morning dip in peak flow is common.

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7
Q

What are the associated symptoms of asthma apart form SOB, cough, wheeze, sputum?

A
  • Reduced exercise ability.
  • disturbed sleep (a sign of severe asthma)
  • Acid reflux
  • eczema, hay fever, allergy
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8
Q

What should you specifically ask about when taking a history from an asthma patient (apart from SOB, cough, wheeze, sputum)?

A

1) Precipitants (e.g. cold air, NSAIDs)
2) Diurnal variation (worse in morning? nightime cough)
3) Excerise tolerance
4) Disturbed sleep (sign of sever asthma)
5) Acid reflux
6) Eczema, hay fever, allergies
7) living conditions - pets, carpet, feather pillow.
8) Job (paint sprayers, welders, animal handler)

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9
Q

What are the examination signs of asthma?

A
  • tachypnoea
  • wheeze
  • hyperinflated chest
  • hyperresonant percussion note
  • reduced air entry
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10
Q

What are the signs of a severe asthma attack?

A
  • inability to complete sentences
  • pulse > 110bpm
  • resp rate >25/min
  • Peak expiratory flow 33- 50% of predicted
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11
Q

What are the signs of a life threatening asthma attack?

A
  • silent chest
  • confusion
  • exhaustion
  • cyanosis (PaO2 < 8 KPa, PaCO2 4.6-6, SPO2 <92%)
  • Bradycardia
  • Peak expiratory flow <33%
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12
Q

What investigations should be done for an acute attack of asthma?

A
  • Peak expiratory flow
  • sputum culture
  • FBC (raised WCC? infective trigger)
  • U & E
  • CRP
  • Blood cultures (sepsis)
  • ABG analysis (low PaO2, and low PaCO2) —> of PaCO2 raised send to ITU as it shows failing resp effort.
  • CXR to exclude infection / pneumothorax
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13
Q

What does a raised PaCO2 in asthma indicate?

A

In an acute attack of asthma the ABG usually shows a low PaO2 and a low PaCO2 (hyperventilation). If the PaCO2 is raised this indicates a failing respiratory effort , the pt should be sent to intensive care. As this is fatal.

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14
Q

What drugs can trigger asthma?

A
  • NSAIDS

- Beta Blockers

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15
Q

What are the investigations for chronic asthma?

A
  • Peake expiratory flow rate
  • spirometry (low FEV1/ FVC) —-> improved FEV1 after beta 2 agonist / steroids.
  • CXR (hyperinflation)
  • skin prick test for allergens
  • Aspergillus serology
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16
Q

What are the differential diagnoses for acute asthma?

A
  • Pulmonary oedema
  • COPD exacerbation
  • anaphylaxis
  • large airway obstruction e.g. foreign body or tumour.
  • Superior vena cava obstruction
  • pneumothorax
  • PE
  • bronchiectasis
  • obliterative bronchiolitis
17
Q

Obliterative bronchiolitis is a differential for asthma in elderly people. What is it also known as and what is it?

A

Obliterative bronchiolitis AKA popcorn lung.

Inflammation and obstruction of the smallest airways (bronchioles).

Symptoms:

  • cough (dry)
  • wheeze
  • SOB
  • feeling tired.
18
Q

What are the associated diseases of asthma?

A
  • acid reflux (GORD)
  • Polyarteritis Nodosa (inflammation, aneurysms of renal and visceral vessels)
  • Churg- Strauss syndrome ( inflammatory disease of small and medium sized blood vessels. The lungs and skin are commonly affected)
19
Q

What is the treatment for chronic asthma?

A

Lifestyle:

  • stops smoking
  • avoid triggers (allergens e.g. animal fur)

Medication:

1) beta 2 agonist (symptom relief) inhaler (salbutamol)
2) Add inhaled steroid (preventor) e.g. beclometasone 200-800 ug/day
3) Add long acting beta2 agonist inhaler (e.g. Salmeterol
4) increase beclometasone
5) regular oral prednisolone

20
Q

How do beta 2 agonists work and how are they given?

A

Beta 2 adrenoreceptor agonists relax bronchial smooth muscle within minutes.
-salbutamol is best given inhaled but can also be given PO or IV.

21
Q

How do corticosteroids work to treat asthma? give an example of a drug, dose and route?

A

Corticosteroids are used as a preventor. They act to reduce bronchial inflammation.

E.g. beclametasone is inhaled but can also be given PO or IV.

Dose starts at 200-800ug/day but can be increased to up to 2000ug/day.

  • predisolone can be given as a short course.

**rinse mouth after inhaling steroid –> risk of oral candidiasis.

22
Q

How does aminophylline work to treat chronic asthma?

A

Aminophylline reduced bronchoconstriction.

It is used as prophylaxis at night to reduce morning dips in peak flow.

given orally.

23
Q

What is involved in emergency treatment of asthma?

A

1) Assess severity of attack:
Severe –> unable to complete sentences, resp rate>25/min, Pulse>110bpm, PEF 33-50%.
Life threatening —> PEF<33%, silent chest, cyanosis, bradycardia, hypotension, confusion, ABG shows normal or high PaCO2 > 4.6 mmHg, SaO2<92%.

2) Immediate treatment:
- Salbutamol 5mg nebulised with O2. (or terbutaline 10mg)
- Hydrocortisone 100mg IV or prednisolone 40-50mg (or both)
- Start O2 (aim sats 94% to 98%)

3) Monitor O2 Sats, Heart rate, resp rate.

24
Q

What are the side effects of salbutamol?

A
  • tachycardia
  • arrhythmias
  • tremor
  • Hypo K+
25
Q

what is spirometry?

A

Spirometry measures the volume of air that the patient is able to expel after full inspiration.

Helps to differentiate between obstructive (COPD, asthma) and Restrictive (fibrosis - size of lung reduced) diseases.

26
Q

What is FEV1?

A

The volume of air that the pt is able to exhale in the 1st second of forced expiration.

27
Q

What is FVC?

A

FVC is the total volume of air that the pt can forcible exhale in one breath

28
Q

What FEV1/FVC ratio predicts obstructive respiratory disease?

A

FEV1/FVC ratio <0.7 is obstructive.

29
Q

What FEV1 % shows moderate COPD?

30
Q

What is VC?

A

VC is vital capacity. The same as FVC but it is the total volume of air expelled when exhaling naturally and slowly.

31
Q

What does the CXR of an asthma pt look like?

A

CXR looks normal but overinflated lungs.

flattened diaphragms.

32
Q

What happens to the Hb level in asthma??

A

Hb may be raised due to prolonged hypoxaemia (secondary polycythaemia)

33
Q

Asthma often involves a productive cough. What is the sputum like?

A

White clear sputum but can be purulent (yellow) when infective exacerbation of asthma.

Year 3 Respiratory Core Conditions (9 decks)

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