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General med - Resp > Asthma > Flashcards

Asthma Flashcards

1
Q

Common features of asthma symptoms

A

Episodic
Diurnal(worse at night or in the early morning)
+/- triggered or exacerbated by exercise,
viral infection, and exposure to cold air or allergens

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2
Q

Medications which may trigger asthma symptoms

A

NSAIDs

Beta-blockers

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3
Q

Examples of high-risk occupations which may be associated with asthma

A

Lab work
Baking
Animal handling
Welding

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4
Q

Why is family/personal history important in asthma diagnosis

A

To check for atopic eczema/dermatitis and/or allergic rhinitis

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5
Q

Which test should be used to confirm eosinophilic airway inflammation to support an asthma diagnosis

A

Fractional exhaled nitric oxide(FeNO) testing

In steroid-naive adults, a FeNO level of 40 parts per billion or higher is considered a positive result

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6
Q

Which tests can be used to detect airway obstruction, when a person is symptomatic

A

Spirometry
Bronchodilator reversibility
variable peak expiratory flow readings

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7
Q

Normal spirometry reading

A

FEV1/FVC ratio is normally greater than 70%

Any value less than this suggests airflow limitation

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8
Q

When are variable peak expiratory flow readings used to diagnose asthma

A

Diagnostic uncertainty after initial assessment, a FeNO test, and/or objective tests to detect airway obstruction

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9
Q

What is considered a positive variable peak expiratory flow readings test

A

A value of more than 20% variability after monitoring at least twice daily for 2-4 weeks

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10
Q

What is complete control of asthma defined as

A 
No daytime symptoms 
No night-time waking 
No need for rescue meds
No asthma attacks 
No limitations on activity 
Normal lung function
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11
Q

Which tool can be used to assess an individual’s baseline asthma status

A

Asthma control questionnaire or asthma control test

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12
Q

Which psychiatric conditions are more associated with asthma

A

Anxiety

Depression

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13
Q

What should asthmatics regularly measure

A

Their peak flow regularly with their own peak flow meter

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14
Q

First line medication for new diagnosis of asthma

A

Short-acting beta-2 agonist

Anyone prescribed more than one SABA per month should be reassessed urgently

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15
Q

Which other class of meds has to be co-prescribed with LABAs in asthma management

A

Inhaled corticosteroids

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16
Q

In which conditions should beta-2 agonists be used with caution

A

Hyperthyroidism
Diabetes mellitus
Cardiovascular disease(including hypertension)
Susceptibility to Q-T interval prolongation
Hypokalaemia
Convulsive disorders

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17
Q

Common side effects of beta-2 agonists

A

Fine tremor
Palpitations
Headache
Seizure

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18
Q

Which condition has been reported in people using nebulised SABA and how can the risk of this be reduced?

A

Acute angle-closure glaucoma

A mouthpiece rather than a mask should be used to minimise exposure of the eyes to the drug

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19
Q

What should be monitored with use of SABAs alongside corticosteroids, diuretics or xanthine derivatives

A

Potassium levels

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20
Q

When should an ICS be added to asthma treatment

A

Use of inhaled SABA x3 a week or more

Asthma symptoms x3 a week or more

Woken at night by asthma symptoms once weekly

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21
Q

When might a higher dose of ICS be required in management of asthma

A

Previous or currently smokers as smoking reduces the effectiveness of ICS therapy

22
Q

How often should ICS initially be used

A

Twice daily initially

Once good control is established, once-daily ICS at the same daily dose can be considered as maintenance therapy

23
Q

What should be checked before trialling add-on therapy in asthma management

A

Adherence
Inhaler technique
Elimination of trigger factors

24
Q

What is the next option after trial of ICS with SABA in management of asthma

A

LABA in addition to low dose ICS

25
Q

When is LTRA taken

A

Oral therapy only taken at night

26
Q

What is the next option after trial of SABA + ICS + LTRA

A

LABA in combination with ICS

Use clinical judgement to continue treatment with LTRA

27
Q

What is the next option if asthma is uncontrolled on a low dose of ICS and a LABA with/without LTRA

A

Offer to change ICS and LABA to a maintenance and reliever therapy (MART) regimen with a low maintenance ICS dose

28
Q

What is MART

A

MART consists of a single inhaler containing both ICS and a fast-acting LABA, which is used for both daily maintenance therapy and the relief of symptoms as required

29
Q

Which additional drug can be used if asthma is uncotrolled on a moderate ICS dose with a LABA(either as MART or fixed-dose)

A

Muscarinic receptor antagonist or theophylline

30
Q

When should maintenance therapy for asthma be reduced

A

If the person’s asthma has been controlled with their current maintenance therapy for at least 3 months

31
Q

Purpose of spacers

A

Increase the proportion of the drug delivered to the airways and reduce the amount of drug deposited int he oropharynx(thereby reducing local adverse effects and reducing the amount of systemic absorption)

32
Q

How often should people with asthma be followed up

A

At least annually to determine whether treatment needs to be changed

33
Q

Factors should be monitored in all patients with asthma

A

Number of asthma attacks(time off work due to asthma)

Nocturnal symptoms

Adherence

Possession of asthma action plan

Exposure to tobacco smoke

34
Q

What should patients on long-term steroid tablets be monitored for

A 
Blood pressure 
Urine or blood sugar(HbA1c)
Cholesterol 
Bone mineral density 
Vision(to assess for cataracts and glaucoma)
35
Q

Which medication may be considered in asthmatics who have ongoing symptoms, despite high-dose inhaled steroids

A

Prophylactic oral macrolide therapy to reduce possibility of exacerbation frequency

36
Q

What should be done before commencing prophylactic oral macrolides

A 
Specialist referral 
Optimisation of other treatments 
ECG to assess QTc interval
Baseline LFTs 
Counselling about adverse effects
37
Q

Definition of moderate acute exacerbation of asthma

A

PEFR more than 50-75% best or predicted (at least 50% best or predicted in children) and normal speech, with no features of acute severe or life-threatening asthma

38
Q

Definition of acute severe acute exacerbation of asthma

A

PEFR 33-50% best or predicted or resp rate of least 25/min in people over age of 12 years

39
Q

Definition of life-threatening acute exacerbation of asthma

A

PEFR less than 33% best or predicted, or oxygen sats of less than 92%, or altered consciousness, or exhaustion, or cardiac arrhythmia, or hypotension, or cyanosis or silent chest or confusion

40
Q

Which factors may warrant a lower threshold for admission in acute exacerbation of asthma despite only being moderate

A 
Age under 18 yrs 
Poor treatment adherence 
Pregnancy 
Psychological problems 
Previous severe asthma attack
41
Q

Management of acute exacerbation of asthma while awaiting admission to hospital

A 
Controlled supplementary oxygen if hypoxic 
Nebulised SABA
Consider nebulised ipratropium bromide 
Consider ICS 
Monitor peak expiratory flow rate
42
Q

Management of acute exacerbation of asthma if hospital admission not required

A 
SABA via large-volume spacer 
ICS(consider quadrupling dose)
Check adherence to ICS
Monitor peak expiratory flow rate 
Consider montelukast in children aged over 2 yrs
43
Q

How often should a SABA be used once asthma symptoms have subsided after an acute exacerbation

A

As required

Up to 4 times a day(not exceeding 4 hourly)

44
Q

When should a person be followed up after an acute exacerbation of asthma

A

Within 48 hours of presentation, if not admitted to hospital

Follow-up all people admitted to hospital within 2 working days of discharge

45
Q

What should be done as follow up for asthmatics after an acute exacerbation of asthma

A 
Review symptoms and checked peak expiratory flow 
Check inhaler technique 
Consider stepping up ICS
Advice regarding avoiding triggers
Vaccinations 
Personalised asthma action plan
46
Q

Definition of forced expiratory volume in 1s(FEV1)

A

The volume exhaled in the first second after deep inspiration and forced expiration, similar to PEFR.

47
Q

Definition of FVC

A

the total volume of air that the patient can forcibly exhale in one breath

48
Q

Typical spirometry findings in obstructive lung disease

A 
Reduced FEV1 (<80% of the predicted normal)
Reduced FVC (but to a lesser extent than FEV1)
FEV1/FVC ratio reduced (<0.7)
49
Q

How long should bronchodilator therapy be stopped prior to spirometry

A

Short-acting beta-2-agonists should be stopped 6 hours prior to testing.
Long-acting beta-2-agonists should be stopped 12 hours prior to testing.

50
Q

Causes of obstructive lung disease

A 
COPD
Asthma
Emphysema
Bronchiectasis
Cystic fibrosis
51
Q

Typical spirometry findings in restrictive lung disease

A

FVC decreased
FEV1 decreased or normal
Absolute FEV1/FVC > 0.7

General med - Resp (11 decks)

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