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Medicine: Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Recurrent episodes of dyspnoea, cough, sputum production and wheeze caused by reversible airway obstruction.

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2
Q

What are the three factors contributing to airway narrowing in asthma?

A
  1. Bronchial muscle contraction
  2. Mucosal inflammation (mast cell and basophil degranulation)
  3. Increased mucus production
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3
Q

What are the key diagnostic factors in asthma?

A
  1. FHx, Hx of atopy (allergic dermatitis, eczema, rhinitis)
  2. Symptoms - increasing dyspnoea and cough, expiratory wheeze
  3. Fall in peak flow readings (improved with bronchodilators)
  4. Exercise limitations
  5. Using reliever inhaler more often
  6. Waking in the night, disruption to ADLs.
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4
Q

What can precipitate asthma?

A

Cold air, exercise, emotions, allergens, infection, pollution, active/passing smoking, NSAIDs, B-blockers, worse at night.

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5
Q

What sort of short-term time pattern does asthma follow?

A

Diurnal - marked morning dip in peak flow is common.

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6
Q

What GI issue is associated with asthma in 50% of cases?

A

Acid reflux - treating it improves spirometry, but not always symptoms.

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7
Q

What is the difference in investigations for asthma in these age groups?

  1. <5 years
  2. 5-16 years
  3. > 17 years
A
  1. Clinical judgement
  2. Spirometry and bronchodilator responsiveness
  3. Spirometry, bronchodilator responsiveness, and fractional exhaled nitric oxide (FeNO)
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8
Q

How is asthma investigated?

A
  1. Spirometry - FEV1/FVC ratio <70%
  2. Bronchodilator reversibility (BDR) - adults 12% improvement in FEV1, children 12% increase.
  3. PEF monitoring with height and sex matched reference ranges, also perform at home and work.
  4. Fractional exhaled nitric oxide (FeNO) - adults >40ppb, children >35ppb = diagnostic
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9
Q

What is the lifestyle advice management in asthma and what advice should you give about medication?

A

Smoking cessation, avoid precipitants, weight loss if overweight, check inhaler technique, monitor PEF BD, educate to enable self-management by altering medication in light of PEF, emergency advice.

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10
Q

What are the step-wise guidelines for asthma management?

A
  1. Occasional SABA PRN, move to step 2 if used >1 daily.
  2. Add low dose ICS (e.g. beclomethasone)
  3. Add LTRA in addition to SABA and ICS.
  4. Add LABA and either keep or remove LTRA depending on responsiveness.
  5. If still uncontrolled, change ICS and LABA to MART (combined).
  6. Up ICS to moderate dose.
  7. Up ICS to high dose, try theophylline or anticholinergics.
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11
Q

What is the mechanism of action of SABA?

A

Relax bronchial smooth muscle, stimulates Na/K causing intracellular K shift.

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12
Q

What are the side effects of SABA?

A

Tachycardia, palpitations, anxiety, tremor, hypokalaemia.

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13
Q

What is the mechanism of action of LABA?

A

Relax bronchial smooth muscle, stimulates Na/K causing intracellular K shift. Helps reduce nocturnal symptoms and morning slip.

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14
Q

What are the side effects of LABA?

A

Without ICS, associated with increased asthma deaths. Muscle cramps.

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15
Q

What is the mechanism of action of ICS?

A

Act over days to reduce bronchial mucosal inflammation and mucus.

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16
Q

What are the side effects of ICS?

A

Oral candidiasis, hoarse voice.

17
Q

What is the mechanism of action of LTRA?

A

Reduces asthma exacerbations, anti-inflammatory.

18
Q

What are the side effects of LTRA?

A

Sore throat, infections.

19
Q

What are the features of a moderate acute asthma attack?

A

Tachypnoea, audible wheeze, PEF 50-75% of normal.

20
Q

What are the features of a severe acute asthma attack?

A

RR >25, cannot complete sentences, PEF 33-50% of normal, tachycardia.

21
Q

What are the features of a life-threatening asthma attack?

A

Silent chest, confusion, exhaustion, PEF <33% of normal, PaO2 <8kPa, sats <92%, bradycardia, hypotension.

22
Q

What is the emergency management of an acute asthma attack?

A
  1. A-E
  2. High flow oxygen to maintain sats 94-98%
  3. Salbutamol nebuliser
  4. If severe add ipratropium to nebs
  5. Hydrocortisone 100mg IV/prednisolone 50mg PO
  6. Reassess every 15mins, if PEF <70%, repeat salbutamol nebs every 15 mins.
  7. Monitor Obs
  8. Single dose magnesium sulphate 2g IV in severe attack.
  9. No improvement - ICU for ventilatory support and IV salbutamol.
23
Q

How is an acute asthma attack patient discharged and followed-up?

A
  1. PEF >75% within 1 hour can be discharged with normal sats
  2. Check inhaler technique, steroid with SABA, written management plan, GP appointment in 2 days, respiratory clinic appointment in 4 weeks.
24
Q

How is an acute asthma attack prevented?

A
  1. Inhaled ICS, LTRA and avoidance of triggers.
  2. Treat obesity, anxiety, smoking, and prompt treatment of bacterial infection.
  3. Check inhaler technique and adherence.
  4. Influenza vaccine.

Medicine: Respiratory (29 decks)

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