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Year 3: Medicine Block CARDIORESPIRATORY year 5 > Asthma > Flashcards

Asthma Flashcards

1
Q

What is the pathophysiology of Asthma?

A

Chronic condition which involves:

  • Reversible airflow limitation
  • Airway hyper-responsiveness
  • Bronchial inflammation

This is due to

  • Smooth muscle hyperplasia and hypertrophy
  • Increased numbers of mucus secreting goblet cells.
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2
Q

What are some immune cells involved in asthma?

A
  • Eosinophils
  • Mast cells
  • T Helper 2 cells
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3
Q

Which mediators are involved in asthma?

A
  • IL3
  • IL5
  • Histamine
  • Leukotrienes
  • Prostaglandins
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4
Q

What are symptoms of Asthma?

A
  • Wheezing attacks
  • Episodic shortness of breath
  • Worse at night
  • Cough (nocturnal cough)
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5
Q

What are some triggers for Asthma?

A
  • Smoking
  • Upper respiratory tract infections – mainly viral
  • Allergens – pollen, house dust mite, pets
  • Exercise
  • Cold air
  • Occupational irritants
  • Pollution
  • Drugs – aspirin, beta blockers (including eye drops)
  • Food and drink – dairy produce, alcohol, orange juice
  • Stress
  • Consider inhaled heroin, pre-menstrual, psychosocial aspects - Severe asthma
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6
Q

What are some investigations done for asthma diagnosis?

A
  • Peak expiratory flow rate (pre and post bronchodilator)
  • Spirometry
  • Carbon Monoxide Transfer test normal in asthma
  • Histamine or Metacholine bronchial provocation test
  • Exhaled Nitric Oxide can demonstrate airway inflammation and index of corticosteroid response to assess efficacy
  • Blood and Sputum test to check for eosinophilia
  • Skin test can be used to find the allergens
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7
Q

What is the management for Asthma?

A

Step 1: Short acting B2 agonists

Step 2: SABA + low-dose inhaled corticosteroid (ICS)

Step 3: SABA + low-dose ICS + LABA

Step 4: SABA + medium-dose ICS + long-acting beta agonist (LABA) +/- LTRA/LAMA

Step 5: SABA + High-dose ICS + long-acting beta agonist (LABA) +/- LTRA/LAMA

Step 6: SABA + High-dose ICS + long-acting beta agonist (LABA) +/- LTRA/LAMA + Oral low dose steroid

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8
Q

What are features of moderate exacerbation of asthma?

A
  • No features of severe asthma
  • PEFR 50-75%
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9
Q

What are features of Acute Severe Asthma?

A
  • Inability to complete sentence in one breath
  • Respiratory rate ≥25 breaths/min
  • Tachycardia of ≥110 bpm
  • PEFR 33%-50% of predicated normal or best
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10
Q

What are features of life-threatening Asthma?

A
  • Silent chest, cyanosis or feeble respiratory effort
  • Exhaustion, confusion or coma
  • Bradycardia or Hypotension
  • PEFR <33% of predicted normal or best (approximately 150 L/min in adults)
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11
Q

What are the features of very severe life threatening Asthma?

A
  • High arterial CO2 >6kPa
  • Severe hypoxaemia arterial O2 <8kPa despite treatment with oxygen
  • Low and/or falling pH
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12
Q

What is the management of Asthma Exarcerbation?

A
  • Oxygen to maintain SpO2 94-98%
  • Oxygen driven bronchodilator and antimuscuranic nebuliser (salbutamol 5mg or terbutaline 10mg) and (ipratropium 0.5mg).
    • Can use a spacer if unavailable
  • Prednisolone 40-50mg or IV hydrocortisone 100mg immediately
  • Give/repeat salbutamol 5mg with ipratropium 0.5mg by oxygen-driven nebuliser after 15 minutes
  • Consider IV magnesium if not resolving
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13
Q

What are things to consider when treating exacerbation of Asthma to further guide management?

A
  • Measurement of Arterial Blood Gases
  • Chest X-ray
  • Correct fluid/electrolytes especially potassium disturbances as result of salbutamol
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14
Q

What are ABG markers of severe in Asthma exacerbation?

A
  • ‘Normal’ or raised PaCO2​ (Pa CO2>4.6 kPa; 35 mmHg)
  • Severe hypoxia (PaO2 <8 kPa; 60 mmHg)
  • Low pH (or high H+)
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15
Q

What additional steps should be taken in life threatening Asthma?

A
  • Urgent ITU or anaesthetist assessment
  • Urgent portable CXR
  • IV aminophylline
  • Consider IV salbutamol if nebulised route ineffective
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16
Q

What are steps to discharging after an Asthma exacerbation?

A
  • PEFR >75%
  • Stop regular nebulisers or 24 hours prior to discharge
  • Inpatient asthma nurse review to reassess inhaler technique and adherence
  • Provide PEFR meter and written asthma action plan
  • In all patients who received nebulised B2 agonists prior to presentation, consider an extended observation period prior to discharge
  • In all patients ensure treatment supply of inhaled steroid and B2 agonist and check inhaler technique
  • If PEF<50% on presentation, give prednisolone 40-50 mg/day for 5 days
  • Arrange GP follow up 2 days post-discharge
  • Refer to asthma liaison nurse/chest clinic within 4 weeks

Year 3: Medicine Block CARDIORESPIRATORY year 5 (28 decks)

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