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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

Define asthma

A

Chronic inflammatory airway disease characterised by variable reversible airway obstruction, airway hyper-responsiveness & bronchial inflammation

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2
Q

Aetiology of asthma

2 contributors

A

Genetic factors

Environmental factors

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3
Q

Aetiology of asthma - genetic

2

A

FH

Atopy

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4
Q

Aetiology of asthma - environmental

7

A 
House dust mites
Pollen 
Pets
Cigarette smoke
Viral respiratory tract infections
Aspergillus fumigatus spores
Occupational allergens
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5
Q

Define atopy

A

tendency for T lymphocytes to drive production of IgE on exposure to allergens

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6
Q

Presenting symptoms of asthma

4

A

Episodic hx/diurnal variation
Wheeze
Breathlessness
Cough (worse in morning & at night)

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7
Q

Precipitating factors for asthma

5

A 
Cold
Viral infection
Drugs (e.g. β-blockers, NSAIDs)
Exercise
Emotions
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8
Q

Checks in history for asthma

2

A

Check for history of atopic disease (e.g. allergic rhinitis, urticaria, eczema)

Ask about any previous hospitalisation due to acute attacks —> idea of severity

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9
Q

Signs of asthma on physical examination

5

A 
Tachypnoea
Use of accessory muscles
Prolonged expiratory phase
Polyphonic wheeze
Hyper inflated chest
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10
Q

Signs of asthma on physical examination - severe attack

4

A

PEFR < 50% predicted
Pulse > 110 bpm
RR > 25/min
Inability to complete sentences

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11
Q

Signs of asthma on physical examination - life threatening attack
(7)

A 
PEFR < 33% predicted
Silent chest
Cyanosis 
Bradycardia
Hypotension
Confusion 
Coma
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12
Q

Investigations for ACUTE asthma

8

A 
Peak flow
Pulse oximetry
ABG
CXR - to exclude other diagnoses (e.g. pneumonia, pneumothorax)
FBC - raised WCC if infective exacerbation
CRP
U&Es
Blood & sputum cultures
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13
Q

Investigations for CHRONIC asthma

4

A

Peak flow monitoring - often shows diurnal variation w/ dip in morning

Pulmonary function test (obstructive)

Bloods
(eosinophilia
IgE level
Aspergillus antibody titres)

Skin prick tests - helps identify allergens

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14
Q

Management for ACUTE asthma

15

A

1) High flow oxygen (100% via non rebreather, aiming 94-98%)

2) Nebulisers (can do both, with 6L/min O2 over 30-60 mins)
* Salbutamol (5mg & back-to-back PRN)
* Ipratropium bromide (0.5mg 4 hrly)

3) Steroids
* 100mg IV hydrocortisone
* Or 50mg prednisolone PO 5 days

4) Magnesium sulphate IV + senior support

5) Further support
* Consider IV aminophylline infusion
* Consider IV salbutamol
* ITU/anaesthetics for intubation

MONITORING
* ECG & electrolytes closely as bronchodilators & aminophylline cause a drop in K+
* Monitor O2 sats, ABG & PEFR every 15-30 min pre & posts SABA

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15
Q

Why is normal PCO2 a bad sign in asthma attack

A

During an asthma attack they should be hyperventilating & blowing off CO2 —> should be low
Normal PCO2 suggests patient is fatiguing

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16
Q

Acute asthma discharge when:

7

A
  • PEF > 75% predicted
  • Diurnal variation < 25%
  • Stable on discharge medication for 24 hrs
  • PO steroids for 5 days
  • TAME advice
  • Follow up
  • GP review in 2 days
  • Resp clinic review in 4 weeks (if admitted)
17
Q

Epidemiology of asthma

adults, children, prevalence

A

Affects 10% of children
Affects 5% of adults
Prevalence appears to be increasing

18
Q

Management for CHRONIC asthma - step 1

2

A

Inhaled short acting β2 agonist used as needed

If needed >1/day move to step 2

19
Q

Management for CHRONIC asthma - step 2

A

+ regular inhaled low dose steroids (beclometasone 400 mcg/day)

20
Q

Management for CHRONIC asthma - step 3

3

A

+ inhaled long acting β2 agonist (LABA)
If inadequate control w/ LABA, increased steroid dose (800 mcg/day)
If no response to LABA, stop & increase steroid dose (800 mcg/day)

21
Q

Management for CHRONIC asthma - step 4

2

A

Increase inhaled steroid dose (2000 mcg/day)

+ 4th drug (e.g. leukotriene antagonist, slow release theophylline or β2 agonist tablet)

22
Q

Management for CHRONIC asthma - step 5

3

A

Add regular oral steroids
Maintain high dose oral steroids
Refer to specialist care

23
Q

TAME

Management for asthma - advice

4

A
  • Technique for proper inhaler use
  • Avoidance – allergens, smoke, dust
  • Monitor PEFR (2-4x daily)
  • Educate – specialist nurse, compliance, emergency action plan
24
Q

Complications of asthma

6

A 
Growth retardation
Chest wall deformity (e.g. pigeon chest)
Recurrent infections
Pneumothorax
Respiratory failure
Death
25
Q

Prognosis of asthma

2

A

May children improve as they get older

Adult-onset asthma is usually chronic

Respiratory (14 decks)

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