Asthma Flashcards
Risk factors for asthma?
Atopy, maternal smoking, low birth weight, bottle fed, air pollution, other IgE mediated conditions: eczema and allergic rhinitis.
Asthma symptoms
Dyspnoea, expiratory wheeze, tightness, cough, reduced PEF
Asthma investigations
Spirometry- FEV1 significantly reduced
FVC- normal
FEV1/FVC- < 0.7
Obstructive lung disease
Asthma management
1st line: SABA e.g. salbutamol. Increases SM relaxation in bronchial walls. Symptoms reliever.
2nd line: Add ICS e.g. beclomethasone/fluticasone. Preventer, take every day.
3rd line: LTRA e.g. Montelukast. Oral daily medication.
4th line: LABA e.g. Salmeterol. Take every day.
If still symptomatic consider a higher dose of ICS.
Only continue LTRA if helpful.
Consider stepping down dose every 3 months.
Acute asthma attack- features
Moderate- PEF 50-70%. No other adverse signs.
Severe- PEF 33-50%. Can’t complete sentences, RR > 25, HR > 110.
Life threatening:
PEF < 33%.
Oxygen sats < 92%. Silent chest, cyanosis, feeble respiratory effort, bradycardia, hypotension, exhaustion, confusion.
Acute asthma assessment
Do ABG if O2 sats < 92%. CXR only recommended if life threatening, suspected pneumothorax or not responding to treatment.
Acute asthma management
Oxygen Salbutamol nebulised Hydrocortisone/prednisolone. Continued for > 5 days. Ipratropium bromide Magnesium sulphate Theophylline/aminophylline Escalate care to ITU
To discharge: No nebulisers or oxygen for 24 hours. Inhaler technique checked. PEF > 75%.