Adult asthma Flashcards
What can cause asthma?
genetic and environment
What are some possible triggers for asthma?
dust, change in weather
What are RF for asthma?
- FHx of asthma
- Exposure to allergic
- History of atopic disease (e.g. eczema, allergic rhinitis
- GORD can make asthma worse
What are symptoms and signs of asthma?
- Recurrent episodes of SOB
- Chest tightness
- Expiratory Wheezing
- Coughing
- Recent upper respiratory tract infection
- Nasal polyposis
- Obstructive symptoms
What are possible DDx for asthma?
- Cystic fibrosis
- Chronic rhinosiniusitis
- Vascular ring
- COPD
- Vocal cord dysfunction
What investigations are used for asthma?
- FEV1/FVC ratio
- PEFR
- CXR
- FBC
- . Fractioned Exhaled nitric oxide
What is FEV1/FVC ratio in asthma?
<80% predicted (obstructive) and FEV1 reduced
What is PEFR in asthma?
- compare to best and normal for height and gender
- peak flow diary: >20% variability over 2-4 weeks
What is CXR for in asthma?
exclude other path and normal or hyperinflated
What is FBC like in asthma?
normal or raised eosinophils and/or neutrophilia
What sort of inflammation happens in asthma?
- Allergens
- Leads to inflammation largely mast cell, IgE and eosinophil mediated
What does the inflammation in asthma lead to?
- Epithelial airway damage
- Vascular smooth muscle hypertrophy
- Airway hyperresponsiveness
- Mucus plugging (normally in exacerbation)
What sort of airway obstruction is in asthma>
- varaible REVERSIBLE airway obstruction
- Intact lung parenchyma
What are signs for asthma?
- Expiratory polyphonic wheeze
- Work of breathing
- Nasal polyps
What does BDR stand for?
bronchodilator reversibility
What is BDR in asthma?
12% and 200ml increase in FEV1 post SABA
What is the fractioned exhaled nitric oxide in asthma?
> 40ppm – if eospipholic inflammation, nitric oxide goes up
What is the fundamentals of asthma treatment?
- Correct diagnosis
- Avoiding triggers
- Stop smoking
- Medication adherence, techniques and psychosocial factors addressed
What is the maintenance/controllers for asthma?
inhaled corticosteroids that reduce inflammation
How should you take the ICS?
- Mainstay of treatment, if taken correct most effective
- Low dose super effective
- High dose has different Mech of action and causes most of side effects
- Start ASAP
What is the reliever medication for?
open airways and make symptoms go away
How does SABA work?
- only makes patient feel better, not as effective in exacerbation or infections
- Increased use predicts exacerbations
When would you use add ons?
more intense meds to reduce symptoms and open airways
What are possible add ons in asthma treatment?
- LTRA: leukotriene receptor antagonist
- LABA: long acting beta agonist
- LAMA: long acting muscarinic antagonist
What is the treatment algorithm for asthma?
- SABA for symptoms control (going out of fashion)
- Low dose ICS + SABA
- Low dose ICS + SABA + LTRA
- Low dose ICS + SABA + LABA
- Low dose ICS + LABA as MART
- Medium dose ICS + LABA alone or as a MART
- High dose ICS + LABA/LAMA/Thephylline
What is important about steps 6-7 in asthma?
with steps 6-7 use MART with low dose ICS and LABA or SABA
What do you need to do at every step of the management?
- Every step review treatment after 4-8 weeks of treatment adherence
- If it works keep it – add other therapies
What should you do if treatment isn’t working for asthma?
- Address adherence and whether it is being taken correctly
2. If patient is adherent and Tx is not working STOP IT
How is MART used for maintenance and reliever therapy?
- ICS to address inflammation
2. LABA to feel good through bronchodilation (short and long acting LABA)
How is MART used for maintenance and taken daily?
- ICS suppress inflammation
- LABA helps improve airway obstruction and can make people feel good
- This LABA effect can help with adherence esp if they are symptomatic looking for relief
How is MART used as a reliever when patient gets symptoms?
- ICS suppress inflammation and will be takem when asthma is worse because people want to take LABA for relief, but extra boost of steroids is not bad
- LABA has short acting function that relieve symptoms and deals with early attacks
- Avoids SABA reliver use without addressing inflammation causing the problem
When are Spacers used?
improve lung deposition of drug
What are possible complications of asthma?
- Obstructive lung disease
- Severe exacerbation
- Moderate exacerbation
- Airway remodelling
- Oral candidiasis, dysphonia due to inhaled corticosteroids
What does an ACT>20 mean?
controlled asthma
What does and ACT<19 mean?
uncontrolled asthma
What is used to determine uncontrolled asthma?
- Risk of future exacerbation
- Multifactorial and distinct from control
- Previous exacerbation in the last year
- How serve previous exacerbations have been
What guidelines are used for asthma management?
GINA
What is occupational asthma?
most common industrial lung disease in developed world
What is occupational asthma due to?
inhaled particulates at work
Symptoms resolve after during holidays
What should you ask if you suspect occupational asthma?
1.. Also what their job involves and whether “dust” in air, bakers, hairdresser
2. Symptoms worse at work?
3, PPE
