Adult Asthma Flashcards
What are the 6 clinical features typically associated with asthma in adults?
- Wheeze
- Shortness of breath
- Coughing (paroxysmal and usually dry)
- Chest tightness
- Difficulty in expiration
- Symptoms tend to be worse at the beginning or at the end of the day, at different points in the week (occupational allergens) or at different times of the year (seasonal allergens)
What is the prevalence of asthma in adults?
5-10%
Does asthma affect more males or females in adulthood?
Females
Explain the pathophysiology of asthma
- Airway inflammation is mediated by the immune system
- Widespread narrowing of the airways and increased airway reactivity
- airway narrowing (either spontaneously or in response to a stimuli)
List three proven risk factors for asthma
- Hereditary predisposition
- Smoking during pregnancy
- Occupation
What is atopy?
The body’s inherited predisposition to develop IgE antibodies in response to exposure to environmental allergens
Name the three professions that are at high risk of asthma
bakers, painters & shellfish workers
List the three unproven but possible risk factors for asthma
- Obesity
- Diet
- The hygiene hypothesis
Why is it thought that obesity and asthma are linked?
Obesity is a pro-inflammatory disorder
Explain the hygiene hypothesis
Modern children are too clean and do not have the microbial diversity that is important in reducing the risk of asthma
Can spirometry be used to diagnose asthma?
Asthma is variable so asthmatic patients may give a normal spirometry or a spirometry which shows evidence of airflow obstruction- it just depends on what kind of a state they are in when they took the test
if a suspected asthmatic gives an obstructed spirometry reading (<0.7), carry out ________________________ to exclude ________
Full pulmonary function tests
COPD
Following full pulmonary function testing, what else ca be done to help give a definitive diagnosis of asthma?
Test the reversibility of the symptoms by giving a beta2 agonist and retesting spirometry after 15 mins or give an oral steroid for 14 days then re-test spirometry
What should a clinician do if a patient is suspected to have asthma but exhibit normal spirometry in the clinic?
Ask the patient to measure their peak flow 2x daily for 14 days. Variability of >20% over the course of the 14 days can point towards asthma.
Airway response tests are also useful
Other than spirometry, what other investigations should be carried out when asthma is suspected?
- Chest Xray
- Skin prick testing to determine atopic status (looking for atopy)
- Total and specific IgE (looking for atopy)
- Full blood count (look for eosinophilia)
What is the difference in heart rate between a moderate, severe and life threatening asthma attack?
Moderate= <110
Severe= ≥110
Life threatening= Brady/arrhythmia
What is the difference in respiratory rate between a moderate, severe and life threatening asthma attack?
Moderate= <25
Severe= ≥25
Life threatening= Poor respiratory effort
What is the difference in peak flow between a moderate, severe and life threatening asthma attack?
Moderate= 50-75% predicted or best
Severe= 33 - 50% predicted or best
Life threatening= < 33% predicted or best
What is the difference in oxygen saturations between a moderate, severe and life threatening asthma attack?
Moderate & severe= ≥ 92%
Life threatening= < 92%
What is the difference in PaO2 between a moderate, severe and life threatening asthma attack?
Moderate & severe= ≥ 8kPa
Life threatening= < 8kPa
What are the two features of a near fatal asthma attack?
Need for mechanical ventilation
Raised PaCO2
Which guidelines are used for asthma management?
SIGN & GINA
What are the 6 SIGN goals of asthma management?
- No daytime symptoms
- No night time waking
- No need for rescue medication
- No asthma attacks
- No limitations on activity (including exercise)
- Minimal side effects of medication
list the 5 non-pharmacological ways to manage asthma
- Exercise
- Smoking cessation
- Weight management
- Flu/pneumococcal vaccinations
- Patient education and self-management plans
Briefly explain the step up and down asthma treatment regime
short acting beta2 agonists
ADD
low dose ICS
ADD
LABA
THEN
(stop LABA if no response to it and increase ICA
If LABA is beneficial but not fully treating, continue LABA and up the ICS to medium dose- other medications can be added if still inadequate)
Which type of inhaler is useful with somebody with poor coordination/dexterity?
Dry powder inhaler
What are short acting B2 agonist inhalers used for? What is the most commonly prescribed one?
Symptom control
Salbutamol
What are the most common side effects of salbutamol?
Tremor and increased heart rate
What is the most commonly used leyukotrine receptor antagonist?
Montelukast
What kind of asthma patients will be prescribed montelukast?
Patients who’s asthma is driven by allergies
Why is theophylline used?
To manage poorly controlled asthma
When is prednisolone used?
In acute asthma exacerbations
Explain how to manage a mild/moderate asthma attack
- Increase inhaler use
- Oral Steroid
- Treat trigger
- Early follow up (12-24hrs)
- Backup plan (if going home)
Explain how to treat a moderate/severe asthma attack
HOSPITAL!
- Nebulised salbutamol/ipratropium
- Oral/IV corticosteroid (IV hydrocortisone)
- IV magnesium
- IV Aminophylline
- Treat triggers
- treat complications, review and refer
