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Z Year3 Resp Conditions > Adult asthma > Flashcards

Adult asthma Flashcards

1
Q

What can cause asthma?

A

genetic and environment

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2
Q

What are some possible triggers for asthma?

A

dust, change in weather

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3
Q

What are RF for asthma?

A
  1. FHx of asthma
  2. Exposure to allergic
  3. History of atopic disease (e.g. eczema, allergic rhinitis
  4. GORD can make asthma worse
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4
Q

What are symptoms and signs of asthma?

A
  1. Recurrent episodes of SOB
  2. Chest tightness
  3. Expiratory Wheezing
  4. Coughing
  5. Recent upper respiratory tract infection
  6. Nasal polyposis
    - Obstructive symptoms
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5
Q

What are possible DDx for asthma?

A
  1. Cystic fibrosis
  2. Chronic rhinosiniusitis
  3. Vascular ring
  4. COPD
  5. Vocal cord dysfunction
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6
Q

What investigations are used for asthma?

A
  1. FEV1/FVC ratio
  2. PEFR
  3. CXR
  4. FBC
  5. . Fractioned Exhaled nitric oxide
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7
Q

What is FEV1/FVC ratio in asthma?

A

<80% predicted (obstructive) and FEV1 reduced

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8
Q

What is PEFR in asthma?

A
  • compare to best and normal for height and gender

- peak flow diary: >20% variability over 2-4 weeks

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9
Q

What is CXR for in asthma?

A

exclude other path and normal or hyperinflated

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10
Q

What is FBC like in asthma?

A

normal or raised eosinophils and/or neutrophilia

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11
Q

What sort of inflammation happens in asthma?

A
  • Allergens

- Leads to inflammation largely mast cell, IgE and eosinophil mediated

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12
Q

What does the inflammation in asthma lead to?

A
  1. Epithelial airway damage
  2. Vascular smooth muscle hypertrophy
  3. Airway hyperresponsiveness
  4. Mucus plugging (normally in exacerbation)
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13
Q

What sort of airway obstruction is in asthma>

A
  • varaible REVERSIBLE airway obstruction

- Intact lung parenchyma

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14
Q

What are signs for asthma?

A
  1. Expiratory polyphonic wheeze
  2. Work of breathing
  3. Nasal polyps
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15
Q

What does BDR stand for?

A

bronchodilator reversibility

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16
Q

What is BDR in asthma?

A

12% and 200ml increase in FEV1 post SABA

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17
Q

What is the fractioned exhaled nitric oxide in asthma?

A

> 40ppm – if eospipholic inflammation, nitric oxide goes up

18
Q

What is the fundamentals of asthma treatment?

A
  1. Correct diagnosis
  2. Avoiding triggers
  3. Stop smoking
  4. Medication adherence, techniques and psychosocial factors addressed
19
Q

What is the maintenance/controllers for asthma?

A

inhaled corticosteroids that reduce inflammation

20
Q

How should you take the ICS?

A
  1. Mainstay of treatment, if taken correct most effective
  2. Low dose super effective
  3. High dose has different Mech of action and causes most of side effects
  4. Start ASAP
21
Q

What is the reliever medication for?

A

open airways and make symptoms go away

22
Q

How does SABA work?

A
  • only makes patient feel better, not as effective in exacerbation or infections
  • Increased use predicts exacerbations
23
Q

When would you use add ons?

A

more intense meds to reduce symptoms and open airways

24
Q

What are possible add ons in asthma treatment?

A
  1. LTRA: leukotriene receptor antagonist
  2. LABA: long acting beta agonist
  3. LAMA: long acting muscarinic antagonist
25
Q

What is the treatment algorithm for asthma?

A
  1. SABA for symptoms control (going out of fashion)
  2. Low dose ICS + SABA
  3. Low dose ICS + SABA + LTRA
  4. Low dose ICS + SABA + LABA
  5. Low dose ICS + LABA as MART
  6. Medium dose ICS + LABA alone or as a MART
  7. High dose ICS + LABA/LAMA/Thephylline
26
Q

What is important about steps 6-7 in asthma?

A

with steps 6-7 use MART with low dose ICS and LABA or SABA

27
Q

What do you need to do at every step of the management?

A
  • Every step review treatment after 4-8 weeks of treatment adherence
  • If it works keep it – add other therapies
28
Q

What should you do if treatment isn’t working for asthma?

A
  1. Address adherence and whether it is being taken correctly

2. If patient is adherent and Tx is not working STOP IT

29
Q

How is MART used for maintenance and reliever therapy?

A
  1. ICS to address inflammation

2. LABA to feel good through bronchodilation (short and long acting LABA)

30
Q

How is MART used for maintenance and taken daily?

A
  1. ICS suppress inflammation
  2. LABA helps improve airway obstruction and can make people feel good
  3. This LABA effect can help with adherence esp if they are symptomatic looking for relief
31
Q

How is MART used as a reliever when patient gets symptoms?

A
  1. 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
  2. LABA has short acting function that relieve symptoms and deals with early attacks
  3. Avoids SABA reliver use without addressing inflammation causing the problem
32
Q

When are Spacers used?

A

improve lung deposition of drug

33
Q

What are possible complications of asthma?

A
  1. Obstructive lung disease
  2. Severe exacerbation
  3. Moderate exacerbation
  4. Airway remodelling
  5. Oral candidiasis, dysphonia due to inhaled corticosteroids
34
Q

What does an ACT>20 mean?

A

controlled asthma

35
Q

What does and ACT<19 mean?

A

uncontrolled asthma

36
Q

What is used to determine uncontrolled asthma?

A
  • Risk of future exacerbation
  • Multifactorial and distinct from control
  • Previous exacerbation in the last year
  • How serve previous exacerbations have been
37
Q

What guidelines are used for asthma management?

A

GINA

38
Q

What is occupational asthma?

A

most common industrial lung disease in developed world

39
Q

What is occupational asthma due to?

A

inhaled particulates at work

Symptoms resolve after during holidays

40
Q

What should you ask if you suspect occupational asthma?

A

1.. Also what their job involves and whether “dust” in air, bakers, hairdresser
2. Symptoms worse at work?
3, PPE

Z Year3 Resp Conditions (20 decks)

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